You Be the Coder:
Neurobehavioral Status Exams
Published on Tue Feb 01, 2000
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: For the CPT code 96115, can you charge this with your initial consult code (i.e., 99244 or 99255)?
Gina M. Factora, Billing Clerk
Neurology Associates, Honolulu
Answer: Codes 99244 (office consultation for a new or established patient requiring a comprehensive history, a comprehensive examination, and medical decision-making of a moderate complexity with counseling and/or coordination of care with other providers or agencies provided consistent with the nature of the problem[s] and the patients and/or familys needs; usually the presenting problem[s] are of moderate to high severity and physicians typically spend 60 minutes face-to-face with the patient and/or family) and 99255 (initial inpatient consultation for a new or established patient requiring a comprehensive history, a comprehensive examination, and medical decision- making of high complexity with counseling and/or coordination of care with other providers or agencies provided consistent with the nature of the problem[s] and the patients and/or familys needs; usually the presenting problem[s] are of moderate to high severity and physicians typically spend 110 minutes at the bedside and on the patients hospital floor or unit) both fall under the evaluation and management (E/M) section of CPT 2000.
Catherine G. Fischer, CPA, reimbursement policy advisor for the Marshfield Clinic in Marshfield, Wis., a regional healthcare system with 650 physicians and more than 50 specialties including neurology, says if two distinct services are provided and documented, then it is important to bill for both, appending the -25 modifier (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code, which indicates that a separate and significant evaluation has been provided in addition to the procedure. Please note that some testing already is included in the E/M neurological examination. Evaluation of higher integrative functions including: orientation to time, place and person, recent and remote memory, attention span and concentration, language (e.g., naming objects, repeating phrases, spontaneous speech), fund of knowledge (e.g., awareness of current events, past history, vocabulary), according to the Health Care Financing Administrations (HCFA) E/M documentation guidelines released in November 1997.
Therefore, if the overall testing exceeds the testing cited in the E/M neurological exam and is aptly described by the wording in CPT code 96115 (neurobehavioral status exam [clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, memory, visual spatial abilities, language functions, planning] with interpretation and report, per hour) and the neurologist documents this additional testing and the time spent performing this service (96115 is time-based), the neurologist should bill for both the E/M and the testing code, appending modifier -25 to the E/M.
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