Psychiatry Coding & Reimbursement Alert

Question: We recently had a denial for 96101 for psychological testing performed by our psychiatrist. The reason for the denial is that there is no documentation for the amount of time spent by our clinician. What kind of documentation should be provided to the payer to allow payment of the testing performed?

Missouri Subscriber

Answer: When reporting 96101 (Psychological testing [includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, e.g., MMPI, Rorschach, WAIS], per hour of the psychologist’s or physician’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report) for psychological testing, you report one unit of the code for every hour that your clinician spends face-to-face with the patient administering the test or interpreting the test results and report preparations. Note that, per CPT®, a minimum of 31 minutes must be provided to report any per hour code, such as 96101. Thus, code 96101 covers 31 to 90 minutes of such testing. At 91 minutes, you can report a second unit of 96101.

Since it is a time based code, your clinician should document in the patient chart notes the exact time that he spent face-to-face with the patient, in interpretation of the tests, and in preparation of the corresponding report. The time documentation should be precise and not approximate time estimation. Also, time spent face-to-face and in interpretation and report preparation should be documented separately, so the payer will know how much of the time was spent with the patient and how much on the interpretation and report of the tests.

If this time documentation has not been done in the previous records that were sent to the payer, you will probably not be able to get any compensation for the number of units of 96101 that you have reported in the original claim, since the payer is seeking such documentation to support the claim.