what insurers need to know about the new psychological ......psychological testing per hour ....

What Insurers Need to Know about the New Psychological & Neuropsychological Testing Codes

Presented November 28, 2018 by

Antonio E. Puente, PhD

Neil H. Pliskin, PhD

CPT Copyright 2017 American Medical Association. All rights reserved.CPT® is a registered trademark of the American Medical Association.

©2018 APA Practice Organization

Promoting and supporting practicing psychologists©2018 APA Practice Organization

Objectives

Describe the new testing codes and definitions

Walk through how to crosswalk from the old codes to the new ones

Apply the new codes using practical examples

Address “frequently asked questions”

2


“Double Dip” Problem Professional Time in Technician Code (Since 2006)

Professional Technician

3


Problems Faced By Psychologists and Insurance Carriers Alike The “double dip” perception when unique work performed by

both the professional and technician on the same day

No clarification of non-face to face work by professional and/or technician

Billing across multiple days of service has been confusing

Single test interpretation vs. data integration

How to code the “Interactive feedback”

Computer screening tests billed as psychological and neuropsychological testing

4


New Testing Code Structure:Base Code for Testing Evaluation Services

Intraservice Work

Postservice Work

PreserviceWork

Preliminary Test SelectionRecord ReviewCall to ascertain referral Q

Interpretation of TestsIntegrationClinical Decision MakingDiagnosis and Tx PlanningCreation of ReportInteractive Feedback

Transcription of ReportReport DistributionArrangement of Referrals

5


New Testing Code Structure

Intraservice Work

Postservice Work

PreserviceWork

Intraservice Work Postservice

Work

PreserviceWork

BASE CODE(Used Once)

ADD-ON CODE(Possibly used multiple times)

6


Central Nervous System Assessments/Tests: Subsections

Three new main subsections have been added to the Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) section of the 2019 CPT® Codebook.

These subsections are: Assessment of Aphasia and Cognitive Performance Testing Developmental/Behavioral Screening and Testing Psychological/Neuropsychological Testing

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7


Psychological and Neuropsychological Testing

The addition of 12 codes to this subsection allows the reporting of services provided during testing of the cognitive and neurobehavioral functions of the central nervous system. Specifically, the new and revised codes describe:

1. Developmental/behavioral screening and testing services & 2. Psychological/neuropsychological testing services.

It is important to note that the addition of the new series of codes is not a one to one cross-walk from the deleted codes.

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8


Central Nervous System Assessments/Tests: Definitions

Neurobehavioral status examination

Neuropsychological testing evaluation services

Psychological testing evaluation services

Interactive feedback

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9


Central Nervous System Assessments/Tests: Definitions (CPT®)

Neurobehavioral status exam: a clinical assessment of cognitive functions and behavior, and may include an interview with the patient, other informant(s), and/or staff, as well as integration of prior history and other sources of clinical data with clinical decision making, further assessment and/or treatment planning and report. Evaluation domains may include acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities.

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10


Central Nervous System Assessments/Tests: Definitions (CPT®), cont.

Psychological testing evaluation services: typically include integration of patient data with other sources of clinical data, interpretation, clinical decision making, and treatment planning and report. It may include interactive feedback to the patient, family member(s) or caregiver(s), when performed. Evaluation domains for psychological evaluation may include emotional and interpersonal functioning, intellectual function, thought processes, personality, and psychopathology.

Neuropsychological testing evaluation services: typically include integration of patient data with other sources of clinical data, interpretation, clinical decision making, and treatment planning and report. It may include interactive feedback to the patient, family member(s) or caregiver(s), when performed. Evaluation domains for neuropsychological evaluation may include intellectual function, attention, executive function, language and communication, memory, visual-spatial function, sensorimotor function, emotional and personality features, and adaptive behavior.

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11


Central Nervous System Assessments/Tests: Definitions (CPT®), cont.

Interactive feedback: used to convey the implications of psychological or neuropsychological test findings and diagnostic formulation. Based on patient-specific cognitive and emotional strengths and weaknesses, interactive feedback may include promoting adherence to medical and/or psychological treatment plans; educating and engaging the patient about his or her condition to maximize patient collaboration in their care; addressing safety issues; facilitating psychological coping; coordinating care; and engaging the patient in planning given the expected course of illness or condition, when performed.

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12

New Testing Code FamilyThirteen new CPT codes that describe developmental/behavioral screening and testing services and psychological & neuropsychological testing services.

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Promoting and supporting practicing psychologists

Psychological Testing Services

1014


Psychiatric Diagnostic Evaluation

90791 Psychiatric diagnostic evaluation

Please note that no changes have been made to CPT® code 90791.

This service includes a comprehensive diagnostic evaluation of psychological and psychosocial conditions and is performed prior to psychological evaluation and test administration and scoring services.

15


Existing vs. 2019 Psychological Testing Codes

90791Psychiatric Diagnostic Evaluation

No Change for 2019

90791Psychiatric

Diagnostic Evaluation

96101

Psychological testing per hour psychologist's or physician’s time

96136Psychological or

Neuropsychological Test Admin/Data Gathering by Physician or other QHP, first 30 minutes

+ 96137Psychological or

Neuropsychological Test Admin/Data Gathering by Physician or other QHP, each addt’l 30 minutes

96102

Psychological testing per hour technician time

96138

Psychological or Neuropsychological Test Admin/Data Gathering by Technician, first 30 mins

+ 96139Psychological or Neuropsychological Test Admin/Data Gathering by Technician, each addt’l 30 mins

96130Psychological

Testing Evaluation, first hour

+ 96131Psychological

Testing Evaluation, each addt’l hour

CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA. 16


Psychological Testing Evaluation Services

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

✚96131 each additional hour (List separately in addition to code for primary procedure)

17


Test Administration & Scoring By Qualified Healthcare Professional

96136 Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes

✚96137 each additional 30 minutes (List separately in addition to code for primary procedure)

18


Psychological Testing and Scoring & Evaluation

BY PROFESSIONAL

Crosswalk

Psychological Testing By Psychologist or Physician

Psychological Testing Evaluation Services By Professional

2018CPT® Code 2018 CPT® Descriptor 2019

CPT® Code 2019 CPT® Descriptor

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

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

96131* each additional hour (List separately in addition to code for primary procedure)

Test Administration and Scoring By Professional

96136**

Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes

96137** each additional 30 minutes (List separately in addition to code for primary procedure)

19


Psychological Testing and Scoring By Technician

96138 Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes


20


Psychological Testing and Scoring By Technician

& EvaluationBy Professional

Crosswalk

Psychological Testing By Psychologist or Physician

Psychological Testing Evaluation Services By Professional



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

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

96131* each additional hour (List separately in addition to code for primary procedure)

Test Administration and Scoring By Technician

96138Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes

96139 each additional 30 minutes (List separately in addition to code for primary procedure)

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Clinical Example : Pediatric ADHD Assessment(1 Diagnostic Interview + 3 hours of psychologist testing + 3 hours of professional evaluation services)

Diagnostic Interview 90791 (1 unit)

Test Administration/Data Gathering By Psychologist First 30 minutes 96136 (Base Code; 1 unit) Each additional 30 minutes 96137 (Add-on; 5 units)

Psychological Testing Evaluation (Professional) Services Hour 1 96130 (Base Code ; 1 unit) Hours 2 & 3 96131 (Add-on; 2 units)



Clinical Example: Adult Pain Assessment(1 Diagnostic Interview + 3 hours of technician testing + 3 hours of

professional evaluation services)

Diagnostic Interview 90791 (1 unit)

Test Administration/Data Gathering by Technician First 30 minutes 96138 (Base Code; 1 unit) Each additional 30 minutes 96139 (Add-on; 5 units)

Psychological Testing Evaluation (Professional) Services• Hour 1 96130 (Base Code ; 1 unit)• Hours 2 & 3 96131 (Add-on; 2 units)



Clinical Example: Adult Pain Assessment- Case with Combined QHP and Technician-Administered Assessment:(1 Diagnostic Interview+ 2 hours of technician testing + 2 hours of psychologist administered testing + 2 hours of professional evaluation services) Diagnostic Interview Hour 1 90791 (1 unit)

Test Administration/Data Gathering Psychologist First 30 minutes 96136 (Base Code; 1 unit) Each additional 30 minutes 96137 (Add-on; 3 units)

Testing Administration/Data Gathering By Technician First 30 minutes 96138 (Base Code; 1 unit) Each additional 30 minutes 96139 (Add-on; 3 units)

Testing Evaluation Services By QHP Hour 1 96130 (Base Code ; 1 unit) Hour 2 96131 (Add-on ; 1 unit)



Neuropsychological Testing Services

2025


Neurobehavioral Status Exam

96116 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgement, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour


26


Neurobehavioral Status Exam

2018CPT® Code

2018 CPT® Descriptor 2019CPT® Code 2019 CPT® Descriptor

96116

Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report

96116

Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgement, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour

96121 each additional hour (List separately in addition to code for primary procedure)

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Psychological/Neurological Testing: A SnapshotA snapshot of the neurobehavioral status examination. Psychological/Neuropsychological Testing

Cognitive Services Test Administration/Scoring

Interpretation and Report or Automated Result

Code Unit Evaluation InteractiveFeedback

Physician or Qualified Health Care Professional

Technician Physician or Qualified Health Care Professional

AutomatedResult

Neurobehavioral Status Examination

96116 Per hour X X X

✚96121 Per hour (add-on) X X X

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Existing vs. 2019 Neuropsychological Testing Codes

96116 Neurobehavioral Status Exam per hour physician or other QHP’s time

+ 96121 Neurobehavioral Status Exam each addt’l hour physician or other QHP’s time

96116 Neurobehavioral

Status Exam

96118Neuropsychological testingper hour psychologist's or physician's time

96136Psychological or Neuropsychological

Test Admin/Data Gathering by Physician or other QHP, first 30 minutes

+ 96137Psychological or Neuropsychological

Test Admin/Data Gathering by Physician or other QHP, each addt’l 30 minutes

96119 Neuropsychological testing

per hourtechnician time

96138Psychological or Neuropsychological Test Admin/Data Gathering by Technician, first 30 mins

+ 96139Psychological or Neuropsychological Test Admin/Data Gathering by Technician, each addt’l 30 mins

96132Neuropsychological Testing Evaluation,

first hour

+ 96133 Neuropsychological Testing Evaluation,

each addt’l hour



Neuropsychological Testing Evaluation Services

96132 Neuropsychological 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


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Use the Testing Evaluation Services Add-On Code (96133) for “Interactive Feedback”

Interactive feedback: used to convey the implications of psychological or neuropsychological test findings and diagnostic formulation. Based on patient-specific cognitive and emotional strengths and weaknesses, interactive feedback may include promoting adherence to medical and/or psychological treatment plans; educating and engaging the patient about his or her condition to maximize patient collaboration in their care; addressing safety issues; facilitating psychological coping; coordinating care; and engaging the patient in planning given the expected course of illness or condition, when performed.



Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) Tables

Psychological/Neuropsychological Testing

Cognitive Services Test Administration/Scoring Interpretation and Report or Automated Result




AutomatedResult

Testing Evaluation Services

96130 Per hour X X Not included in Code

Not included in Code X

✚96131 Per hour (add-on) X X Not included in Code


96132 Per hour X X Not included in Code


✚96133 Per hour (add-on) X X Not included in Code




Test Administration & Scoring By Qualified Healthcare Professional (e.g. clinical neuropsychologist)

96136 Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes


33


Neuropsychological Testing and Scoring &Evaluation Services by Professional Crosswalk

Neuropsychological Testing By Psychologist or Physician

Neuropsychological Testing Evaluation Services By Professional

2018CPT® Code


96118

Neuropsychological testing (eg, 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

96132*

Neuropsychological 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

96133*each additional hour (List separately in addition to code

for primary procedure)


96136**

Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes

96137**each additional 30 minutes (List separately in addition to code

for primary procedure)

34


Neuropsychological Testing & Scoring By Technician

96138 Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes


35


Neuropsychological Testing and Scoring

by Technician & Evaluation Services

by Professional Crosswalk

Technician AdministeredNeuropsychological Testing

Neuropsychological Testing Evaluation Services By Professional

2018CPT® Code


96119

Neuropsychological testing (e.g., Halstead-ReitanNeuropsychological 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

96132*

Neuropsychological 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

96133*each additional hour (List separately in addition to code for primary procedure)

Test Administration and Scoring by Technician

96138**Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes

96139**each additional 30 minutes (List separately in addition to code for primary procedure)

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Clinical Example: Differential Diagnosis of Memory Loss/Early Alzheimer’s Disease (2 hours NSE + 4 hours of psychologist testing + 2 hours of professional evaluation services)

Clinical Interview/Neurobehavioral Status Examination (NSE) Hour 1 96116 (Base Code; 1 unit) Each additional hour 96121 (Add-on; 1 unit)

Test Administration/Data Gathering Psychologist First 30 minutes 96136(Base Code; 1 unit) Each additional 30 minutes 96137 (Add-on; 7 units)

Neuropsychological Testing Evaluation (Professional) Services Hour 1 96132 (Base Code; 1 unit) Hour 2 96133 (Add-on; 1 unit)



Clinical Example:A 46-year-old male with a history of coronary artery disease and recent myocardial infarction with reported symptoms of memory loss, anxiety, and depression (1 hour NSE+ 4 hours of technician testing + 2 hours of professional evaluation services) Clinical Interview/Neurobehavioral Status Examination (NSE) Hour 1 96116 (Base Code; 1 unit)

Test Administration/Data Gathering By Technician First 30 minutes 96138 Each additional 30 minutes 96139 (Add-on; 7units)


CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.38


Clinical Example:A 46-year-old male with a history of coronary artery disease and recent myocardial infarction with reported symptoms of memory loss, anxiety, and depression- Case with Combined QHP and Technician-Administered Assessment:(1 hour NSE+ 2 hours of technician testing + 2 hours of psychologist testing + 2 hours of professional evaluation services)

Clinical Interview/Neurobehavioral Status Examination (NSE) Hour 1 96116 (Base Code; 1 unit)

Test Administration/Data Gathering Psychologist First 30 minutes 96136 (Base Code; 1 unit) Each additional 30 minutes 96137 (Add-on; 3 units)

Test Administration/Data Gathering By Technician First 30 minutes 96138 (Base Code; 1 unit) Each additional 30 minutes 96139 (Add-on; 3 units)


CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.39








AutomatedResult

Test Administration & Scoring

96136 Per 30 min Not included in Code

Not includedin Code X Not included in

CodeNot included in Code

✚96137 Per 30 min (add-on)

Not included in Code

Not included in Code X Not included in


96138 Per 30 min Not included in Code



✚96139 Per 30 min (add-on)






Single Psychological or Neuropsychological Automated Testing & Result

3441


96103 Psychological

testingadministered by computer

96120 Neuropsychological

testingadministered by computer

96146 Psychological or

Neuropsychological Test Admin, Single Automated Instrument

Existing vs. 2019 Automated Test via Electronic Platform

42


Automated Testing and Result

96146 Psychological or neuropsychological test administration, with single automated instrument via electronic platform, with automated result only

43


Psychological & Neuropsychological Testing By Computer

Single Psychological or Neuropsychological Automated Test with Automated Result



96103

Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, e.g., MMPI), administered by a computer, with qualified health care professional interpretation and report 96146

Psychological or neuropsychological test administration, with single automated instrument via electronic platform, with automated result only

96120

Neuropsychological testing (e.g., Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report

Crosswalk for 2019 Computerized Test CPT® Codes

44


Clinical Example:A 70-year-old female presents with a history of failing memory. Her physician arranges for the administration of a single automated cognitive test handed to her by the clinical staff.

Psychological or neuropsychological test administration, with single automated instrument via electronic platform, with automated result only

1 Unit 96146

[No physician work, just practice expense][Use of two or more tests requires Testing Evaluation Services]









AutomatedResult

Test Administration & Scoring

96146 Automated report(s)



CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.

©2018 APA Practice Organization

46


CPT Code RVUs Neurobehavioral Status Exam

96116 First Hour 2.70

✚96121 Each additional hour 2.32

Test Evaluation Services96130:

Psychological Testing Evaluation Services

First hour 3.30

✚96131 Each additional hour 2.5196132:

Neuropsychological testing evaluation

services

First hour 3.71

✚96133 Each additional hour 2.83

2019 Psychological and Neuropsychological Testing CPT® Codes & Total RVUs

47


CPT Code RVUs


96136 First 30 minutes 1.33

✚96137 Each additional 30 minutes 1.23

By Technician

96138 First 30 minutes 1.08

✚96139 Each additional 30 minute 1.08

Automated Testing and Result

96146Single automated instrument via electronic platform, with automated result only

0.06

2019 Psychological & Neuropsychological Testing CPT® Codes & Total RVUs, cont.

48


Frequently Asked Questions

49


Frequently Asked Questions

If both the psychologist and the technician (under the supervision of the psychologist) provide test administration and scoring services during the evaluation, can both Test Administration and Scoring codes 96136-96139 be used to document the time spent by each?

How should we bill for services that take place over multiple days?

What about the scenario where you complete the testing but can't meet with the family for feedback for a few weeks?

50


In progress- Model LCD and Users Guide

APA Practice Organization: www.apapracticecentral.org

Click on Reimbursement in the top menu.

If you have additional questions, please contact APA’s Office of Health Care Financing at [email protected].

Additional resources on the new testing codes

51

http://www.apapracticecentral.org/

mailto:[email protected]


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what insurers need to know about the new psychological ......psychological testing per hour ....

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