Primary Care Coding Alert

Question: Recently, our provider administered a Wechsler Adult Intelligence Scale (WAIS) test on one of our older patients following an evaluation and management (E/M) service. The patient returned a day later to meet with the provider and discuss the results of the test and care plan implementation. In addition to the E/M, can we code 96130 for the test administration and +96131 for the follow-up encounter?

Codify Subscriber

Answer: Even though the test and the follow-up occurred on different days, you cannot bill 96130 (Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour) for the first encounter and +96131 (… each additional hour (List separately in addition to code for primary procedure)) for the second.

This is because all the services you mention are incorporated in the descriptor for 96130, which means that you would report them with one code even when different parts of the service occur on different days. However, you could possibly use both codes as they are time-based. Code +96131 is an add-on code with a threshold of 31 minutes; so, if the length of the both the initial and follow-up encounters is between 91 minutes and two hours, you would code this as 96130 with +96131 x 1.

Don’t forget: 96130 is a column 2 code for 99201 through 99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …), so you will either need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to your E/M code or modifier 59 (Distinct procedural service) to 96130 to unbundle the services.