Psychiatry Coding & Reimbursement Alert

Question: A nurse practitioner at our facility is scheduled to perform neuropsychological testing for a patient suffering from dementia. I am not too much aware of the codes that I need to report for the service. Please keep me informed of the other guidelines surrounding this service so that I will be aware of what is right and wrong.

San Francisco Subscriber

Answer: Your nurse practitioner is authorized to perform neuropsychological testing to the extent authorized under State scope of practice. You will have to report the services provided by your nurse practitioner using 96119 (Neuropsychological testing [e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test], with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face) or 96120 (Neuropsychological testing [e.g., Wisconsin Card Sorting Test], administered by a computer, with qualified health care professional interpretation and report), depending on whether the testing is administered by a technician or a computer.

Don't make the mistake of coding the services provided by your nurse practitioner with 96118 (Neuropsychological testing [e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test], 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) as you need to use this code when the neuropsychological tests are performed by a physician or a clinical psychologist only.

It is important to note that non-physician practitioners such as nurse practitioners (NPs), clinical nurse specialists (CNSs) and physician practitioners (PAs) are exempted from having to perform neuropsychological tests under the general supervision of a physician or a clinical psychologist. However, as described by section 1861(aa)(6) of the Social Security Act, which is the basic Medicare statute, nurse practitioners and clinical nurse specialists should perform these services in collaboration with a physician.

For more information on Medicare regulations and guidance related to this issue, visit the CMS site at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R85BP.pdf.