345 B-1 ImPACT Billing VOD - Podell 55461

B-1 ImPACT Billing Info Table of Contents
Webinar: Title: Speaker:
B-1 (Intermediate) ImPACT Billing Kenneth Podell, PhD
Goals for this webinar include the following: - Terminology and Descriptions - Review of CPT Codes for Billing - Review typical diagnosis codes - Documentation - Review common testing and billing scenarios for ImPACT - Discuss using modifiers Table of Contents for Handouts Section 1: Section 2: Section 3: Section 4: Speaker Biography Slides (Presentation Handouts) Other Helpful Handouts FAQ from Workshop Attendees
Description: This 90-minute course addresses billing insurance companies for doctor visits. It covers CPT and diagnosis codes, recordkeeping, and examples how to bill insurance companies for post-injury testing with the ImPACT program. This webinar is a must-see for anyone who deals with insurance companies! This course is 60 minutes of presentation followed by 30 minutes of Q & A.
Certificate of Completion Issued to All Registered. BOC Credits available for Athletic Trainers.
B-1 ImPACT Billing Section 1: Bio
Billing with ImPACT Webinar Speaker: Kenneth Podell, PhD

Dr. Kenneth Podell is the Co-Director at The Methodist Concussion Center, The Methodist Hospital System in Houston, Texas.
Biography
Dr. Podell received his MA and PhD in Psychology at The City University of New York. He did his pre-doctoral and postdoctoral training at The Medical College of Pennsylvania. Dr. Podell has been instrumental in developing ImPACT and has made several national presentations and authored articles on computerized assessment in evaluation concussion.
Dr. Podell is a board certified neuropsychologist (ABPN) and a Fellow of The National Academy of Neuropsychology. He has had prior academic appointments at The Medical College of Pennsylvania and Drexel University. He is a reviewer for various scientific journals. Dr. Podell has in the past work at a neuropsychological consultant for the Detroit Red Wings as part of the NHL concussion program. He also consults with various colleges and athletic programs assessing and caring for their concussed athletes.
Guide to ImPACT Billing
B-1 ImPACT Billing Section 2: Slides
Billing Through Insurance Companies for ImPACT
Kenneth Podell, Ph.D., FACPN

Co-Director The Methodist Concussion Center The Methodist Hospital System Houston, Texas
Overview
Terminology and descriptions Review of CPT codes for billing Review typical diagnosis codes Documentation Review common testing and billing scenarios for ImPACT Q&A
Copyright 2012 by ImPACT Applications, Inc. All rights reserved. No part of this publication may be reproduced in whole or in part or transmitted in any form or by any means without the prior written permission of ImPACT Applications, Inc. For information regarding permission, please write to ImPACT Applications, Inc., copyright@impacttest.com ImPACT and associated logos are trademarks of ImPACT Applications, Inc.

Terminology
CMS = Centers for Medicare & Medicaid Services CPT = Current Procedural Terminology codes ICD-9 = International Statistical Classification of Diseases and Related Health Problems RVU = Relative Value Units Face to Face = Time spent with the patient Facility/Non-facility = Hospital or skilled nursing home vs all others
CMS - Centers for Medicare & Medicaid Services

Design, pass and over see diagnoses and billing regulations for Medicare and Medicaid.
Most insurance companies follow CMS, but regional variations occur. Local insurance decisions trump Medicare
Even Medicare has regional districts that can vary in its decisions.

CPT Current Procedural Terminology Codes
Developed, copy protected and published by the American Medical Association (AMA)
But mandated by CMS and HIPPA To order 1.800.621.8335
Used to report the procedures and services being submitted for payment Over 7,500 CPT codes
40-60 for psychologists
ICD-9/10 (International Statistical Classification of Diseases)

The coding of diseases, symptoms and problems by The World Health Organization
ICD 10 has 155,000 codes (in effect starting 2013)
ICD-9 had 17,000
ICD-9 Grouped by systems

Codes 290-319 are mental health/psychiatric dx Codes 320-358 are neurological disorders Codes 800-999 are a mix of other dx
850-854 intracranial injury including concussion (850.X).

RVU Relative Value Unit
A common scale used to determine the value of the procedure
Each CPT code has a RVU
Used in determining reimbursement fee Based upon (in order of complexity):

Type of Provider: Surgeon, Physician, Psychologist, midlevel provider and technician (52%)
Difficulty of the healthcare providers work including time, complexity, mental effort, judgment and stress. Expenses of healthcare provider for that procedure
Regional variations
Malpractice insurance for that procedure (4%)

Direct and indirect costs
CMS RVU Values
Code 96116 96118 96119 96120
RVU 1.86 1.86 0.55 0.51
CPT Code Definitions
CPT Codes
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 psychologists or physician's time, both face-to-face with the patient and interpreting test results and preparing the report.

Explanation of 96116
(AMA CPT Assistant, November, 2006)
A neurobehavioral status exam is completed prior to the administration of neuropsychological testing. The status exam involves clinical assessment of the patient, collateral interviews (as appropriate and review of prior records). The interview would involve clinical assessment of several domains including but not limited to; thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving and visual spatial abilities. The clinical assessment would determine the types of tests and how those tests should be administered.
CPT Codes - Tips

96116 is pseudo-equivalent to 90801 but should be used under different circumstances 96116 is time based meaning you bill the time spent
90801 is not time based
Is estimated to last 75-90 mins and requires intensive record review and full mental status exam
Use 96116 when interviewing collaterals (parents, ATC, other healthcare professionals), reviewing records, etc.

CPT Codes - Tips
96116 is designed to be used with neurological or non-mental health ICD codes while 90801 is to be used with the mental health codes.
ICD-9 320-359 or 850s
CPT Codes
96118: Neuropsychological testing (e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scale and Wisconsin Card Sorting Test), per hour of the psychologists or physician's time, both-face-to-face time with the patient and time interpreting test results and preparing the report. 96118 is also used in those circumstances when additional time is necessary to integrate other sources of clinical data, including previously completed and reported technician and computer-administered tests..

Code 96118 is reported for the neuropsychological test administration by the physician or psychologist with subsequent interpretation and report by the physician, or psychologist. It is also reported for the integration of information obtained from other sources which is then incorporated in the more comprehensive interpretation of the meaning the tests results in the context of all testing and assessments. The administration of the tests is completed for the purposes of a physical health diagnosis.
CPT Billing Tip
Use 96118 to bill for all feedback, communicating or team conference time. Can bill all of the time on the last date of service.
This is how you can bill for all of your time, even the 10 minute increments spent on the phone.

CPT Codes
96119: Neuropsychological testing (e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scale and Wisconsin Card Sorting Test), with qualified health care professional interpreting and report, administered by technician, per hour of the technician time, face-to-face.
(AMA CPT Assistant, November, 2006) The qualified health professional has previously gathered information from the patient about the nature of the complaint and the history of the presenting problems. Based on the clinical history, a final selection of tests to be administered is made. The procedures are explained to the patient, and the patient is introduced to the technicians, which administers the tests. During testing, the qualified health professional frequently checks with the technician to monitor the patients performance and make any necessary modifications to the test battery or assessment plan. When all tests have been administered, the qualified health professional meets with the patient again to answer any questions.

96119
Requires general supervision. Psychologist or physician must be available to the technician.

Exceptions are physician assistants, nurse practitioners and clinical nurse specialists who do not need supervision to bill for the service.
Is for face-to-face testing time only.

Can bill for scoring time if done while patient is in the same room doing something else.
CPT Codes
96120 - Neuropsychological testing
(e.g., WCST) administered by a computer (unsupervised) with qualified health care professional interpretation and the report
10

Code 96120 is reported for the computer-administrated neuropsychological testing, with subsequent interpretation and report of the specific tests by the physician, psychologist, or other qualified health care professional. This should be reserved for situations where the computerized testing is unassisted by a provider or technician other than the installation of programs/test and checking to be sure that the patient is able to complete the tests. If greater levels of interaction are required, though the test may be computerized administer, then the appropriate physician/psychologist (96118) or technician code (96119) should be used.
Billing Multiple CPT Codes On The Same Day

Rules have changed.
Use 96118 to bill for integration and interpretation of any 96116, 96119 or 96120 billed. 96118 can be billed same day for report writing and integration/synthesis of the tests in combination. Cannot bill for individual interpretation of each test administered under 96116, 96119, or 91620 See MM5204
11

Coding Tip
(AMA CPT Assistant, November, 2006) All of the testing and assessment services also require interpretation in the context of other clinical assessments performed by a qualified professional as well as prior records. The use of the term interpretation in the codes is this integrative process. It is not the scoring or interpretation of the result of a specified tests or tests. The scoring process and more limited interpretation is part of the test administration services whether by physician/psychologist, technician and/or computer.
Coding Tip (AMA CPT Assistant, November, 2006)

If the service provided is less than one hour, append Modifier 52, Reduced Services. After one hour has been completed, time is rounded. It is not unusual that the assessments may include testing by a technician and a computer with interpretation and report by the physician, psychologist or qualified health professional. Therefore, it is appropriate in such cases to report all 3 codes in the family of 96101-96103or 96118-96120.
12
Coding Tip (AMA CPT Assistant, November, 2006)

Typically, the psychological testing services, 96101-96103, the neurobehavioral status exam, 96116, and the neuropsychological testing services, 96118-96120, are administered once per illness condition or when a significant change in behavior and/or medical/health condition necessitates re-evaluation.
-this allows for re-assessment of post-concussion injury because change in condition (i.e., improvement to RTP)
Reimbursement
13

2011 CMS Avg Reimbursement Rates does not reflect SGR cuts
CPT Code 90801 96118 Description
Psych. Dx interview NP testing by Psych. NP testing by tech. NP testing by Computer 2010 2011 2010 2011 2010 2011 2010 2011
Office Fee
$153.64 $153.91 $100.63 $97.17
% change
+0.0 -3.00
96119
96120 96116
$67.81 $70.33
$72.85 $82.22 $93.06 $91.06
+3.7
+12.8
Neurobehavioral Status Exam - 2010 2011
-2.2
Physician Fee Schedule Search

CMS web site has searchable database
https://www.cms.gov/apps/physician-feeschedule/search/search-criteria.aspx
Extremely useful database Can search by code(s) with modifiers for regional, local or national carriers For reimbursement, RVUs, Geographical Practice Cost Index
14

Information About Reimbursement
Qs about Medicare Reimbursement
202-336-5889 or pracgov@apa.org
Complete pay formula published in the July 13, 2009 Federal Register, Vol. 74, No. 132, pgs. 33526-22552.
Documentation
15

Documentation Crossing your Ts and Dotting Your Is
Mandated by CMS so applies for any Medicare/Medicaid billing May not be required by private insurers, but BC/BS mandates it. Documentation applies to office notes as well as report. Documentation must support the intensity of the procedure, medical decision making complexity and number of units billed.
Time submitted on bill is not enough documentation

CPT code must reflect the documentation in the medical record Documentation must be legible and include:
Date Reason for encounter Record review History taking and exam relative to chief complaint Assessment with results Treatment plan
16

Recommendation
Keep a log or chart activity form where you document date with beginning and end time for each procedure Interviews, testing, scoring, report writing, and feedback and any other work is dated with start and stop times.
I have separate face sheet where this is recorded and initialed Talk of incorporating this into reports
17
ICD 9 Diagnosis Codes
ICD-9 Codes For Sports Concussion Assessment

Concussion Includes: commotio cerebri Excludes: concussion with: cerebral laceration or contusion (851.0-851.9) cerebral hemorrhage (852-853) head injury NOS (959.01) 850.0 With no loss of consciousness 850.1 With brief loss of consciousness
Loss of consciousness for less than one hour
850.2 With moderate loss of consciousness

Loss of consciousness for 1-24 hours
850.3 With prolonged loss of consciousness and return to pre-existing conscious level
Loss of consciousness for more than 24 hours with complete recovery
850.4 With prolonged loss of consciousness, without return to preexisting conscious level 850.5 With loss of consciousness of unspecified duration 850.9 Concussion, unspecified Must include date of injury when submitting bill
18

ICD-9 Codes For Sports Concussion Assessment
Post-concussion syndrome - 310.2 Post-contusion syndrome or encephalopathy Posttraumatic brain syndrome, nonpsychotic Status post-commotio cerebri Use additional code to identify associated posttraumatic headache, if applicable (339.20-339.22) Excludes: any organic psychotic conditions following head injury (293.0-294.0) frontal lobe syndrome (310.0)
Billing Tip
Match procedure code with category of ICD dx.
If using ICD 850.X codes must use 96116 for interview portion If using ICD 310.2 must use 90801
19

Potential Billing Issues
Simultaneous Use of Professional &Technical Codes
Currently Allowed by Medicare

https://questions.cms.hhs.gov/cgibin/cmshhs.cfg/php/enduser/print_alp.php?faq_ar ray=9177,9179,9176,9180,9181,9182,9183,9178> MLN Matters: MM5204 Revised, Effective December 28, 2006
Potential Problems with Simultaneous Use of Test Codes

United Health Care & Aetna may start excluding the use of professional and technical codes simultaneously Ingenix, and other computerized edit systems, may be disallowing simultaneous test codes Compliance officers at large institutions
20

Potential Problems with Billing Codes
Some insurance policies (BC/BS) only allow one date of NP testing per year, so must bill all procedure codes on the same day.
Modifier 59 & Testing Codes

Distinct Procedural Services
When a procedure or service is independent or distinct from other services performed on same day.
Modifier is not applicable if the professional provides the service or if 96118 is billed on different day. If the technician provides the service, it is advisable to use the 59 modifier. The modifier should be applied to any of the testing codes though probably best to attach to technician and/or computer codes (CMS, September,
2006)
21

Official Q & As from CMS Regarding Testing Codes
https://questions.cms.hhs.gov/cgibin/cmshhs.cfg/php/enduser/print_alp.php?faq_a rray=9177,9179,9176,9180,9181,9182,9183,917 8 Probably will not be further revised and additional concerns will be handled at the local carrier level
Simultaneous Use of 90801 and 96116
Under No Circumstances are the Psychiatric (90801) and Neurobehavioral Status Examination (96116) codes to be used simultaneously
22
Billing Scenarios
Testing Scenario I - Self

Activity 1. Brief discussion with trainer 2. Interview & brief neurological and balance exam with athlete 3. Brief interview with parent (if a minor) 4. ImPACT testing (in the room) 5. Review results and discuss concussion and return to play with athlete and parent 6. Brief report (dictated) 7. Feedback with ATC next day 8. Feedback with parent two days later Time 10 minutes 40 minutes 15 minutes 30 minutes 20 minutes 20 minutes 15 minutes 15 minutes
Total Time=
165 minutes
$ 91.06 $194.34 $285.40
Billing
96116 1 unit (interview with pt and parent) 96118 2 units (#s 1 and 4-8 = 110 minutes round up to 120 minutes)
can use last date of service for billing all 96118 activity
23

Testing Scenario - Computer
Activity 1. Brief discussion with trainer 2. Interview & brief neurological and balance exam with athlete 3. Brief interview with parent (if a minor) 4. ImPACT testing (patient alone) 5. Review results and discuss concussion and return to play with athlete and parent 6. Brief report (dictated) 7. Feedback with ATC next day 8. Feedback with parent two days later
Total Time=
Time 10 minutes 40 minutes 15 minutes 30 minutes 20 minutes 20 minutes 15 minutes 15 minutes 165 minutes $91.06 $82.22 $97.17 $270.45
Billing
96116 96120 96118 1 unit (interview with pt and parent) 1 unit (computerized testing - pt alone) 1 unit (#s 1,5,6,7, and 8 = 80 min. round down to 60)
Testing Scenario III - Examiner

Activity
1. Brief discussion with trainer 2. Interview & brief neurological and balance exam with athlete 3. Brief interview with parent (if a minor) 4. ImPACT testing (examiner in room) 5. NP testing by examiner 6. Scoring by examiner 7. Review results and discuss concussion and return to play with athlete and parent 8. Brief report with interpretation (dictated) 9. Feedback with ATC next day 10. Feedback with parent two days later
Time
10 minutes 40 minutes 15 minutes 30 minutes 75 minutes 30 minutes 20 minutes 20 minutes 15 minutes 15 minutes
Billing
96116 96119 96118 1 unit (interview with pt and parent) 2-3 units (bill for scoring time if done in room with pt) 1 unit $ 91.06 $140.33/210.99 $ 97.17 $328.56/398.89
24

Testing Scenario III - Physician
Tend not to use neuropsych testing codes. E/M codes and 96120 used. Commonly used E/M Codes (moderate/high complexity)
Initial Assessment 99204/5 New outpatient 45/60 mins 99244/5 Office consult 60/80 mins Follow-up (depending upon complexity) 99242/3 /4/5 Established OP of low to high complexity 99242/3/4/5 Office consult of low to high complexity
Also include 96120 (computerized testing)

Use of modifier 25 with E/M code Need separate documentation ImPACT website has template for rejection/explanations
Helpful Links
http://www.nanonline.org/NAN/PAIC/CPTCodes.aspx http://www.div40.org/Committee_Activities_Pages/Advis ory_Committee/prac_corner.htm http://icd9cm.chrisendres.com/icd9cm/
ICD-9 lookup
https://questions.cms.hhs.gov/cgibin/cmshhs.cfg/php/enduser/print_alp.php?faq_array=91 77,9179,9176,9180,9181,9182,9183,9178
https://questions.cms.hhs.gov/cgibin/cmshhs.cfg/php/enduser/std_alp.php?p_sid=HCq8v6j&p_lva=9174&p_li=&p_accessibility=0&p_page=1&p_cv=&p_pv=3.605& p_prods=8%2C57%2C605&p_cats=&p_hidden_prods=&prod_lvl1=8&prod_ lvl2=57&prod_lvl3=605&p_search_text=&p_new_search=1&p_search_type =answers.search_nl (Q&A about NP CPT codes)
25

Helpful Links
http://www.cdc.gov/nchs/icd.htm
Government site for ICD-10 codes
http://www.nami.org/Template.cfm?Section=Pari ty1&Template=/ContentManagement/ContentDis play.cfm&ContentID=45313

NAMI mental health parity laws by state
Thank you!!
26
MLN Matters Number: MM5204 Related CR Release Date: February 29, 2008 Related CR Transmittal #: R85BP
Related Change Request (CR) #: 5204 Effective Date: January 1, 2006 Implementation Date: December 28, 2006
Psychological and Neuropsychological Tests Note: This article was revised on March 3, 2008, to reflect a revision made to CR5204. The article was changed to correct a reference in the first paragraph of the Background section to section 1861 (s)(2)( c) of the Social Security Act . The correct section number is 1861 (s)(3). Also, the CR release date, transmittal number, and Web address for accessing CR5204 were changed. All other information remains the same. Provider Types Affected Providers who bill Medicare carriers or fiscal intermediaries (FIs) for the provision of diagnostic psychological and neuropsychological tests Provider Action Needed
STOP Impact to You Effective January 1, 2006, carriers and FIs will pay (under the Medicare physician fee schedule (MPFS) database) for diagnostic psychological and neuropsychological tests that are within the CPT code range of 96101 through 96120. CAUTION What You Need to Know The Centers for Medicare & Medicaid Services (CMS) announces the revision of the CPT codes for psychological and neuropsychological tests (codes 96101 through 96120) to include tests performed by technicians and computers (CPT codes 96102, 96103, 96119 and 96120) in addition to those performed by physicians, clinical psychologists, independently practicing psychologists and other qualified non-physician practitioners (as described in Background, below). GO What You Need to Do Make sure that your billing staffs are aware of the CPT code changes.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
Page 1 of 4
MLN Matters Number: MM5204 Background
Related Change Request Number: 5204
Medicare Part B coverage of psychological tests and neuropsychological tests is authorized under section 1861(s)(3) of the Social Security Act, and payment for these tests is authorized under section 1842(b)(2)(A) of the Social Security Act. The CPT codes for these tests are included in the range of codes from 96101 to 96120. The appropriate codes when billing for psychological tests are: 96101, 96102, 96103, 96105, 96110, and 9611; and when billing for neuropsychological tests are: 96116, 96118, 96119 and 96120. All of the tests under this CPT code range 96101-96120 are covered and indicated as active codes under the MPFS database. More specifically, CR 5204, from which this article is taken, provides that (effective January 1, 2006) the CPT codes for psychological and neuropsychological tests include tests performed by technicians and computers (CPT codes 96102, 96103, 96119 and 96120) in addition to tests performed by physicians, clinical psychologists, independently practicing psychologists and other qualified nonphysician practitioners. These changes, made in accordance with the final physician fee schedule regulation, were published in the Federal Register on November 21, 2005, at 70 FR 70279 and 70280 under Table 29 (AMA, Relative Value Update Committee (RUC) and Health Care Professional Advisory Committee (HCPAC) Recommendations and CMS Decisions for New and Revised 2006 CPT Codes). You should be aware of some supervision requirements for diagnostic psychological and neuropsychological tests. First, under the diagnostic tests provision, all diagnostic tests are assigned a certain level of supervision. Generally, regulations governing the diagnostic tests provision allow only physicians to provide the assigned level of supervision for such tests; however, for diagnostic psychological and neuropsychological tests, there is a regulatory exception that allows either a clinical psychologist (CP) or a physician to perform the assigned general supervision. Moreover, nonphysician practitioners such as nurse practitioners (NPs), clinical nurse specialists (CNSs), and physician assistants (PAs), who personally perform diagnostic psychological and neuropsychological tests are excluded from having to perform these tests under the supervision requirements of the diagnostic psychological and neuropsychological tests benefit, that is, under the general supervision of a physician or a CP. In fact, rather than providing them under the requirements for diagnostic psychological and neuropsychological tests, NPs and CNSs must perform such tests under the requirements of their respective benefit. Therefore, NPs and CNSs must perform them in collaboration (as defined under Medicare law at section 1861(aa)(6) of the Act) with a physician. Likewise, PAs must perform these tests under the general supervision of a physician as required for services furnished under the PA benefit.
Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
Page 2 of 4
MLN Matters Number: MM5204
To continue, physical therapists (PTs), occupational therapists (OTs) and speech language pathologists (SLPs) are authorized to bill three test codes (96105, 96110, and 96111) as sometimes therapy codes. However, when PTs, OTs and SLPs perform these three tests, they must do so under the general supervision of a physician or a CP. You should also note that expenses for diagnostic psychological and neuropsychological tests are not subject to the outpatient mental health treatment limitation, which is the payment limitation on treatment services for mental, psychoneurotic and personality disorders as authorized under Section 1833(c) of the Social Security Act. Further, the payment amounts that are billed for tests performed by a technician or a computer reflect a site of service payment differential for the facility and non-facility settings. Remember that CPs, NPs, CNSs and PAs are required by law to accept assigned payment for psychological and neuropsychological tests. And although Independently Practicing Psychologists (IPPs) are not required to accept assigned payment for these tests, they must report the name and address of the physician who ordered the test on the claim form when billing for tests. (An IPP is any psychologist who is licensed (or certified) to
practice psychology in the State or jurisdiction where furnishing services or, if the jurisdiction does not issue licenses, if provided by any practicing psychologist. Examples of psychologists (other than CPs) whose psychological and neuropsychological tests are covered under the diagnostic tests provision include, but are not limited to, educational psychologists and counseling psychologists.) Additionally, there is no authorization under Medicare law for payment for
diagnostic tests when performed on an incident to basis. Following is a summary of who may bill for diagnostic psychological and neuropsychological tests, and references for the review of qualifications, when appropriate. Providers that May Bill for Diagnostic Psychological and Neuropsychological Tests
CPs NPs to the extent authorized under State scope of practice. CNSs to the extent authorized under State scope of practice. PAs to the extent authorized under State scope of practice. Independently Practicing Psychologists (IPPs) PTs, OTs and SLPs See qualifications under Chapter 15, sections 220-230.6 of the Medicare Benefits Policy Manual. See qualifications under Chapter 15, section 160 of the Medicare Benefits Policy Manual. See qualifications under Chapter 15, section 200 of the Medicare Benefits Policy Manual. See qualifications under Chapter 15, section 210 of the Medicare Benefits Policy Manual. See qualifications under Chapter 15, section 190 of the Medicare Benefits Policy Manual.
Page 3 of 4
MLN Matters Number: MM5204
The Medicare Benefits Policy Manual is available at http://www.cms.hhs.gov/Manuals/IOM/list.asp#TopOfPage on the CMS website. Here are some other important things that you should know. The technician and computer CPT codes for psychological and neuropsychological tests include practice expense, malpractice expense and professional work relative value units. Therefore, CPT psychological test code 96101 will not be paid if you include it in the bill for the same tests or services performed under psychological test codes 96102 or 96103. Similarly, CPT neuropsychological test code 96118 will not be paid when included in the bill for the same tests or services performed under neuropsychological test codes 96119 or 96120. Note, however, CPT codes 96101 and 96118 can sometimes be paid separately, when billed on the same date of service for different and separate tests from 96102, 96103, 96119 and 96120. Under the MPFS, there is no payment for services performed by students or trainees. Accordingly, Medicare does not pay for services represented by CPT codes 96102 and 96119, when performed by a student or a trainee. However, the presence of a student or a trainee while the test is being administered does not prevent a physician, CP, IPP, NP, CNS or PA from performing and being paid for the psychological test under 96102 or the neuropsychological test under 96119. Fiscal intermediaries will continue to pay claims from providers of outpatient Part B therapy services (including physical therapy, occupational therapy, and speechlanguage pathology) for CPT codes 96105, 96110 and 96111 with revenue codes and corresponding therapy modifiers (42X with GP, 43X with GO, and 44X with GN, respectively). Finally, your carriers and fiscal intermediaries do not have to search their files to either retract payment for claims already paid, or to retroactively pay claims to January 1, 2006; they will adjust claims that you bring to their attention.
Additional Information You can find more information about Psychological and Neuropsychological Tests by reading CR 5204, located at http://www.cms.hhs.gov/Transmittals/downloads/R85BP.pdf on the CMS website. As an attachment to this CR, you will find updated relevant portions of Publication 100.02 (Medicare Benefit Policy Manual), Chapter 15 (Covered Medical and Other Health Services), Section 80.2 (Psychological Tests and Neuropsychological Tests) If you have any questions, please contact your carrier or FI at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS website.
Page 4 of 4
Billing Helpful Handouts
B-1 ImPACT Billing

Section 3: Handouts
PHYSICIAN BILLING FOR ImPACT Initial Visit

If the patient is referred to your office by another physician, ATC, APRN, etc. you may bill it as a consult using the consult codes 99243-5. You can base the visit on time or fulfill the number of bullets (criteria) required for each of the above three codes. Most patient encounters are usually a 99244 or 5.
You will need the NPI number of the person referring the patient to your office when you bill and will need to send a consult letter to the referring individual if you bill a consult code. You should not bill a consult without an NPI number (I usually also enclose a copy of my note and the ImPACT test.)
For Consults Not Paid by MCOs

Another alternative (if your insurance company does not pay for consults) is to use the new patient or regular patient office visit codes. New Patient codes are: 99204 or 99205 Old patient codes are: 99214 or 99215 Since initial visits are usually 30-60 minutes long most are billed as a 4 or 5
Billing Helpful Handouts

ImPACT tests (non-baseline tests) should be billed as 96120 in addition to the CPT code. (Most insurance companies do not reimburse for baseline tests so these need to be paid by the patient.) You need to have an interpretation of the test included either in your note or in a separate note. Many (most in our area) insurance companies will reimburse for these tests. Some may require precertification or they will not pay for them. You need to check individually with each managed care company in your area. For those insurance companies not paying for ImPACT the patient is responsible for the charge.
B-1 ImPACT Billing

Section 3: Handouts
FOLLOW-UP CONCUSSION VISITS

The code used for these visits are usually a 99213 or 99214 plus the 96120 code (ImPACT test interpretation). Again, the 99213 or 99214 can be based on time (25 minutes for a 99214) or on having the appropriate bullets under HPI, ROS, PFSH and P.E. If it is based on time you need to write what was discussed.
B-1 ImPACT Billing Section 4: FAQ
Frequently Asked Questions Billing ImPACT
Training Workshops/Webinars
Answers
Questions from Workshop Attendees

Q: To make sure I am clear, physicians would only use E&M and 96120 and never use the 96116 and 96118? Q: 99215 is an E&M Code? Q: Would it be possible for an ATC to conduct unsupervised ImPACT tests & provide interpretation for physicians or neuropsychologists in an off-site location and then bill by attaching to the physician or neuropsychologists code? Q: So no modifier is needed with 96118 & 96116 on the same day? Q: Do most insurance cover sports injuries in your experience or are they exclusions? Q: If the physician actually administers and enters data into the computer for the ImPACT tests, and the patient does not use the computer, do you bill code 96118? Q: Do you recommend us follow the CMS rule on mod 52? If 45 minutes or less, use mod 52 or 45? Q: So a physician CAN bill 96116, 96118 and 96119? We are not using a neuropsych, so we would bill those VS the E&M?
A physician can use either E&M codes or neuropsych testing codes. You probably cannot use the E&M and 96116 testing codes on the same date. You should be able to use the E&M code with 96120 but you might have to add the 25 modifier to the E&M code. Correct. An ATC is not authorized to bill 96118, 96116 or 96120. A neuropsychologist or physician can bill 96119 under his/her doctor code for the time spent by the ATC as well as 96120 for the unsupervised computer administration of ImPACT.
Correct. They are generally covered by insurances. Remember, how he/she received the concussion (sports, fall or accident) is not an issue for insurances companies. Yes.
It is recommended that you check with the specific carrier/insurance company. Yes, a physician can bill 96116, 96118 and 96119. However, typically they would bill the appropriate E&M (type and complexity) rather than bill 96XXX codes.
ImPACT's products provide information regarding potential cognitive decline and related symptoms that may be experienced after head trauma. ImPACT's products are not diagnostic, do not determine whether an individual has a particular head or brain injury and should not be used to make a return to play decision without an examination by a qualified and licensed health care professional. Many jurisdictions have rules and regulations governing the process and procedures under which an individual may be returned to play. Please check the rules and regulations in your state, county, organization and/or school district for legal requirements and further guidance. www.impacttest.com
Page 1
Q: I am wondering how to bill the 96118: Do we bill per follow-up visit, or do we wait until we have 31 minutes (keep track of time) or more and then bill it out? Q: What if there was no face-to-fact contact with the patient on the last date of service when billing 96118? Is it still allowable to use this date of service without patient contact when using the accumulated time? Q: Im not clear on when you use EM code? Q: You first bill 96116 when a patient follows up, how is that recommended to be coded? Q: Can you bill an EM level with ImPACT test on first visit? Q: Would billing/coding be different based on testing site -- i.e. PCP office vs. Urgent Care vs. Sports Medicine MD? Q: We do all of our testing in an office setting. I always bill the 96120 with an office visit code. Is that right?
You can bill multiple visits using 96118 on the last date of service by adding them all up. It is recommended that you retain good documentation of DOS and amount of time of each visit in case of an audit. Yes. This assumes that there was face-to-face contact during the first visit. In fact, this is a common scenario.
Physicians would use an E&M for the initial and follow-up evaluations and assessments of a sports concussion. Yes, you would bill 96116 as the initial interview and subsequent time can be billed under 96118. Yes, assuming you meet the requirements of the E&M code being billed. In general, no. The only issues would entail with how the offices are designated (outpatient or hospital base). Even then, billing and coding is the same, but reimbursement is different. Unsure what you mean by office visit code. If that means an E&M code and 96120, they can bill for that -- and they should consider using modifier 25 (answered above).
Page 2
Q: Are there any dx codes you recommend using with the 96120 to help insurance companies pay? Q: I was told at a billing course that ImPACT could be billed by our Occupational Therapist utilizing 96125 Standardized Cognitive Performance Testing. We do a battery of other tests in conjunction with ImPACT. Have you seen any issues with non-physician providers such as Occupational Therapists charging for this test? Our physicians are interpreting the reports, but I am not sure how they are billing for that. Q: In scenario 1, if a nurse practitioner performed the ImPACT test with the patient, how might the billing change? Q: Could 96120 be used for ImPACT baseline testing? An example could be providing ImPACT baseline testing in preseason for a HS football player or team. Q: If a doctor hasnt billed a 96120 can they go back and resubmit the bill with the 96120 code?
Yes for ICD-9 850.x (concussion codes).
Yes, I suspect they can. However, this assumes the OT stays in the room the entire time when the athlete is taking ImPACT. I would recommend billing 96120 instead. The reimbursement rate is higher and after setting up the athlete, the OT can do other work while the athlete is taking the test.
A nurse practitioner does not require supervision for billing 96119 and can bill for it independently. Alternatively, they can bill 96120 (if they do not stay in the room with the athlete). Please consider the reimbursement rate before deciding which the best option is. Baseline testing is not billable to ones health insurance.
Yes, if it was actually done.
Q: Is there ever a time when a physician will be That is not a combination we have seen. It is recommended that you bill an E/M + 25-mod, + 96116 + 96118? the appropriate E/M code with the 25 modifier and 96120. The physician would likely reach the higher level of complexity by billing all aspects of the exam (expect 96120) under the E/M which would probably yield a higher reimbursement rate then billing the lower E/M complexity with 96118. We do not think one can bill 96116 and the E/M code as there is too much overlap between the two.
Page 3
Q: We are new to this and want to understand the billing; all services are billed with the last date of service, even the initial visit (99215) which may have been held 4 days prior? Q: With the ImPACT codes can you also bill a 99215? Q: If a patient has BC/BS and they come back for a 2nd ImPACT, is there any way for it to be covered? Q: When you say physician, can a pediatrician perform the ImPACT and bill these codes? Q: What are typical charges for baseline testing?
Not exactly. Only 96118 is combined and billed on the last date of service. The E/M codes are billed on the date administered.
You can bill 99215 if you reach the criteria for the code. Yes. Bill it the same way you billed the initial evaluation using E/M or neuropsych testing codes, making sure you meet all the criteria for each code. Yes.
It varies greatly anywhere from $5-$75, depending upon your goal. Please consider your costs and expectations for offering baseline testing.
Q: On the activity log, what date of service do It depends. This pertains only to the neuropsych testing codes; 96118 can you use for the combination of your time? The be performed over multiple days, combined and all billed on the last date last date of service? of service. Q: But if there is no Psy can a Physician use the 96116 and 96118 if he does not do a full ROS or Exam to reach a 99204 or 99244? Q: What codes (if any) can ATCs or PTs direct bill for ImPACT Testing if there is no physician on site? Yes.
Difficult to answer. ATCs or PTs can act as technicians and bill 96119 under the doctor code assuming that the definition of supervision has been met.
Q: In Wisconsin, we are told to bundle the E/M This is a specific regional carrier issue that is likely highly idiosyncratic. into the 96120. You show billing separately for the E/M and the test. Some carriers inform us to bill the codes separately. Do you have any references to back up the billing of each code separately?
Page 4
Q: Can the physician bill for baseline ImPACT testing of large groups? Q: Can you bill 96119 and 96118 on same date? Our athletic trainer charges 96119 AND physician bills 96118 on same day. We are getting denied stating there is an NCCI edit.
One cannot bill health insurance for baseline testing. However, the schools or individuals can be billed (similar to a physical). You should be able to bill 96119 and 96118 on the same date of service, per CMs and Medicare. Please refer to my slides. However, some ins co deny it. I would mention the Medicare ruling on that (MM5240). Other options include billing the 96118 on the next day (so if the physician did his report the next day you can bill the 96118 as the day after the 96119 and DOS. Then it should not be denied. I know of no insurance company that pays for baseline testing. The physician would bill the E/M codes and the neuropsychologist would bill the neuropsych codes. No. No need for supervision. 96120 is an unsupervised code billed under Physician or Ph.D.
Q: Is it possible, and if so how, can a physician and a neuropsychologist bill for one patient in the same day? Q: If using 96120 is an ATC a qualified healthcare professional, as it applies to 96120? Does this code have the "general supervision" rule like the 96119? Q: Would you use code 96116 to bill for graded exercises with an exercise physiologist under a physician? Q: Can you use this same documentation and billing procedures if we are implementing RTP graded exercise protocol under the supervision of our medical director? I know our competitor is billing this way but would like to confirm. Q: Have you had difficulty getting reimbursed when using multiple ImPACTs testing dates to track athletes recovery and make RTP decision?
No.
Yes, but I do not know what billing code you would use not any of the codes I discussed.
Occasionally. However, if you do too many and there is no change in status then I can see why it will be rejected. You are only allowed to assess one time for the same condition. So if there is no change and you have multiple assessments I can see why they are sometimes rejected (assuming different dates of service. If you try to bill multiple 96120 with the same 96118 then all but one 96120 will be rejected as you can only have on 96120 per eval. (Defined by the 98118.
Page 5
Q: If a patient has mental health benefits do the neuropsych CPT and ICD codes have to go to the mental health carrier as opposed to medical claims? Q: I'm in a rehab clinic and we have a medical director who interprets the test that I have administered during a full PT evaluation. Can I bill 96119 or is it better to just include my time and cost of test into our evaluation charge? Q: Do you have any information for physical therapy clinics performing the test?
Depends how NP testing is covered by insurance. If it is covered under the medical benefits then use an 850 code and bill under medical. If it falls under mental health use 310.2 and bill under mental health You can bill 96119, but in order to bill 96119 it must done under the physician with 96118, which I doubt he is billing. Also, you must stay in the room while the patient takes ImPACT in order to bill 96119. The physician can bill 96120 if you set up the pt and let them complete ImPACT alone. A physical therapist (PT) can administer ImPACT as a technician under a physician or psychologist only. PTs cannot bill for the administration, reporting, or interpretation directly. The denial is specific to the rules of that insurance carrier. I would check with their written rules for 96120. After reviewing them see what would need to be changed to have 96120 approved. It may be a separate report for ImPACT scores. It is difficult to know how to respond without seeing the insurance carriers rules. The CPT code 96118 is the professional code and can only be used by a full licensed psychologist or physician. It entails all aspects of your evaluation including preparation time, testing time, scoring time, report writing and any other time directly related to your evaluation (e.g., communicating information to a trainer or parent). There is a separate interview code (96116), however, there is strict time and procedures that must be part of the interview in order to use it (e.g., fully documented mental status examination). Alternatively, if the interview does not reach the 96116 threshold the time can be billed using 96118. Both are time based codes where one unit equals one hour of time spent performing the service and the reimbursement is higher for 96118. The general rule is to round to the nearest hour. If you do 70 minutes of testing you bill for one hour or one unit. If you tested for 91 minutes you bill for two hours or units.
Q: We are using modifier 25 on our E/M with the 96120 but keep getting denials telling us to reference billing guidelines. Any thoughts?
Q: When should I use the 96118 CPT code?
Page 6
Q: Does the CPT Code need to match with the diagnosis?
Yes, the CPT procedure code and the diagnosis codes (ICD-9 and not DSMIV) do need to match. By that I mean whether or not they are either mental health codes or medical codes (terms used by the insurance companies and not meant to be pejorative). Diagnosis codes are easily divided into mental health codes (290.0 319) or medical codes (all others with nervous system codes ranging from 320 389.9). The designation of the neuropsychological procedure codes as being either medical or mental health based is tricky and often idiosyncratic and dependent upon the individual insurance company. For example, some insurance companies consider neuropsychological testing a mental health service and as such will only allow for a mental diagnosis when billing. Other insurance companies consider it a medical procedure and require a medical diagnosis (non-mental health). Still for some companies it goes either way but the coverage for neuropsychological testing is drastically different. Even more confusing is the fact that the same insurance company offers different coverage depending upon the patients individual policy and plan. Simply put, you need to contact the patients insurance company and determine the benefits for that given policy and plan. For example, some polices might say that if a medical diagnosis is used (for example ICD-9 850.X or Concussion diagnosis) that neuropsychological testing would fall under the medical benefit and no preauthorization is required and testing is covered at X%. Other insurance companies might say that neuropsychological testing is a mental code and one must use a mental health diagnosis (in that case use ICD-9 310.2 code of post concussion syndrome) and that pre-authorization is required or that benefits are only covered at X%.
Q: How do I know whether the procedure should be coded as being medical or mental health?
Page 7
The CPT code 96119 is the technical code and is used for face-to-face testing only. This CPT code is for an individual who performs direct administration of neuropsychological tests that is less than fully licensed at the Ph.D. level. There is no minimal educational requirement so it would include post-doctoral fellows, interns, and psychometrists (at either the Masters level or Bachelors degrees). The operative phrase is face-toface. One can only bill for the time the technician actually administers the tests. Scoring time is not billable, unless the scoring is done in the same room when the patient is completing something else (such as a questionnaire or computerized testing). While this may seem counterintuitive (or even a complete contradiction in terms), the technician is still face-to-face and as such could bill for time scoring when the patient is completing a form and being supervised by the technician. Otherwise, non- face-to-face scoring time (for example: when done after the patient has left) is not billable. Also, any preparation time, interviewing or report writing done by the technician (if they were a psychology intern or postdoctoral fellow, for example) is not billable. CPT code 96119 is a time based code identical to 96118. Bottom line is that reimbursement is a very fickled thing and often without a consistent pattern. For example, my regional Blue Cross Blue Shield in 2005 always allowed for neuropsychological testing of sports concussion as long as I used a diagnosis of Concussion (ICD-9 850.X). However, in 2006 they are reversing this and saying I need to use a mental health diagnosis (ICD-9 310.2 post-concussion syndrome). In my experience, I have found that most carriers will cover neuropsychological testing for sports-concussion as long as you know their rules. This document will help you to learn some of the rules necessary to be reimbursed.
Q: Do you have any advice on being reimbursed consistently?
Page 8
Q: What are some typical reimbursement rates?
One can bill all they want, but the question I am sure everyone has is it profitable? Again that depends on the reimbursement rates of the individual carriers you deal with. However, CMS set the rate for CPT procedure codes(see the table below) which is used by commercial FFS (fee for service) insurance companies when setting their own rates. Please note that there are different reimbursement rates depending upon if you are a hospital based or out-patient based facility. The distinction may not be that simple. Many out-patient clinics part of a larger health care organization may be designated as a hospital facility even if they are not attached to a hospital. For example, I work within a large non-profit hospital system. My clinic is in a building several blocks from the hospital. There is only one outpatient clinic in our building with the rest being administration. However, all buildings within our system are designated as hospital-based and as such receive the lower reimbursement rate. The reason for the lower reimbursement rates for hospital-based facilities has to do with CMSs Medicare payments that cover resident training and care of Medicare patients. Reimbursements Rates set by CMS 96116 96118 96119 96120 $96.95/unit $96.59/unit $33.28/unit $25.32 (flat rate) $103.83 $124.09/unit $63.31/unit $45.94 (flat rate)
Some of you may be having trouble with individual carriers telling you that these new codes are not reimbursable. Federal law states that all carriers must acknowledge these codes (i.e. reimbursable). Whether an insurance company includes it in their policy is a different matter. An example of a carrier incorrectly excluding the codes is Wisconsin Medicare, which covers Wisconsin, Illinois, Minnesota and Michigan, whose current policy states that 96119 is not a reimbursable code. This is wrong and there is a lot of political and legislative action to correct this. Michigan Blue Cross and Blue Shield acknowledged the codes as of January 2006, but decided not to reimburse them until starting April 1, 2006 and making it retroactive.
Page 9
Q: What is the relationship between when services were rendered and the date of service for billing purposes?
The answer to this problem is rather simple. Use the last date of rendered services as the date of service (DOS) for billing. Often times it has been my experience that our professional services rendered for a sports concussion evaluation can extend beyond the evaluation date. There are telephone calls with trainers, referring physicians and parents. Often times I like to follow up with a call to the parents. All of this is billable time, but you can not bill for 10 minutes on one day and 25 minutes on another. However, you can combine them into the testing time with the DOS being the last date of services rendered. You might want to explain this to the parent so they do not think you billed incorrectly. There is one other neuropsychological testing code, 96120, that is used for any unsupervised computer based testing. It is a onetime charge that is not time based. Please note that if the technician or psychologist is in the room while the athlete is testing you would bill the time it took the athlete to complete ImPACT using either 96119 or 96118 (depending upon who is in the room) rather than the computer code. You cannot bill for both. It is more financially advantageous to be in the room while the athlete completes ImPACT, as the reimbursement rate is higher The retaking of ImPACT can be billed for as part of a medical service. However, the person administering ImPACT must be working for the physician/psychologist seeing the athlete and you must bill the correct location site. As a neuropsychologist, I bill 96116, 96118, 98120 and 96119 (if I use an examiner/technician). Remember, the dx code is based upon the referral question and not your clinical diagnosis. So, I use the 850.x codes. If I must use a psychiatric-based dx as determined by the regional carrier, then I would use 310.2 (post-concussion syndrome).
Q: If you are working as an Athletic Trainer in a school, can you bill for administering baseline and retake of ImPACT tests? Q: What are the billing codes that Dr. Podell typically uses and has the most success with in terms of reimbursement? Either with cognitive diagnoses or those that are more psychiatric in nature.
Page 10
Q: What are some possible billing scenarios?
The example below is a common scenario encountered in my practice and is for descriptive purposes only. They are not meant to indicate the exact amount of time one needs to spend on a particular case. All cases are different and some can take much longer. Technically I would bill for two (2) units of 96118 (rounding to closet hour) and all billed on the last date of service. Scenario 1:
Activity 1. Interview & brief neurological and balance exam with athlete 2. Brief interview with parent (if a minor) 3. Brief discussion with trainer 4. ImPACT testing (in the room) 5. Review results and discuss concussion and return to play with athlete and parent 6. Brief report (dictated) Total Time = Time 40 minutes
15 minutes 10 minutes 30 minutes 20 minutes
20 minutes 135 minutes
Scenario 2. Imagine if we take scenario 1 and in this case the post-concussion scores were at baseline but the athlete was still symptomatic. Often times I would continue to work with the trainer and family tracking symptom scores and helping explain symptoms to parents and how to avoid exacerbation of symptoms. Sometimes I need to write a letter to the school excusing the player from school work. If all this took an additional 30 minutes over several days it would increase my billable time to 165 minutes. I would document my time spent and in this case submit for three (3) hours of 96118 (round to nearest hour) on the last date I did any service on the case (e.g., talking with the trainer about exerting the athlete once his symptoms resolved).
Page 11
Scenario 3. Lets take scenario 1 but instead of being in the room while the athlete completed ImPACT, I decided to be in my office doing other work. This would change my billing to the following: two hours or units of 96118 and one unit of 96120. See below for the difference in reimbursement using CMS rates for an outpatient facility.
In the room during testing Three units of 96118 = $372.27 Not In The Room During Testing Two Units of 96118 = $248.18
One unit of 96120 $ 45.94 Total = $372.27 Total = $294.12
One can see that it is financially better to be in the room during the testing. One could be doing work while the athlete takes the test but as long as you are in the room supervising the testing it is billable at the higher 96118 rate. There are times when additional neuropsychological testing is required. The same scenario holds in that the reimbursement is higher when the fully licensed neuropsychologist or physician performs the testing, plus scoring time is billable. Compared to when a technician tests and the rate is lower (almost half) and scoring time may not be billable if done away from the patient. Q: My insurance company will not pay for ImPACT because I am not a Psychologist. What can I do? There are many different ways to bill for ImPACT. I have, with great difficulty, managed to have most of the payers in Connecticut pay for the ImPACT test code 96120, which I charge at each visit. On the initial visit, I bill a 99244 or 99245 for all patients referred to me that are not my patients. I then send those physicians or trainers a cover letter and copies of my note and ImPACT test. Follow-up visits are billed as a 99214. Patients that I have seen before I bill as a 99215 with no cover letter (obviously) and follow-ups as a 99214. Other than one or two MCOs I have been paid reasonably well for these visits. All insurers except for one (ironically, the one that serves the self-insured teachers union of Wisconsin) pay for this code. This includes big hitters like
Q: Do you get paid if you use code 96120? Do you bill the 96120 with a qualifier?
Page 12
United Healthcare, which is the dominant insurance in our market. 96120 has no time value or parameter. It is merely for the testing and interpretation of the testing. The only thing I've encountered in the use of this code previously, is that somewhere along the line, some of the coders understood that this was to be a one-time use code. Because on average I'll ordinarily do just over two tests per concussion, I have essentially ignored the one-time use advice, and to my knowledge have consistently gotten paid for it. I think it would be a problem if people over tested in an attempt to "ring the bell" on productivity Q: What should I do if the insurance company is saying we do not hold the specialty for the 96120 code? CPT 96120 indicates that one needs to be a "qualified health care professional" to bill for an "interpretation and report". It does NOT indicate that one needs to be a neuropsychologist to use this code. (It also doesn't indicate that it is a onetime use code as many coders will assume.) Successful reimbursement in this case is often a matter of establishing you are "qualified". That would most easily be substantiated by showing them a certificate of completion from an ImPACT training course or achieving CIC status as determined by ImPACT and listed on www.impacttest.com . ImPACT yields objective, reliable, valid, normed data on verbal and visual memory, processing speed, and reaction time, all of which are parameters of neuropsychological/psychological performance or functioning. http://www.aetna.com/cpb/medical/data/100_199/0158.html "Psychological tests assess a range of mental abilities and attributes, including achievement and ability, personality, and neurological functioning. Psychological testing, including neuropsychological assessment, utilizes a set of standardized tests, whose validity and reliability have been established empirically. They allow for an assessment of a patient's cognitive and behavioral functioning and an analysis of changes related to mental or physical disease, injury, or abnormal development of the brain. Research has shown that the scores from these tests are reproducible and can be compared to those of normal persons of similar age, sex and demographic background to yield valid conclusions."
Q: How can I get proof that ImPACT is actually a neuropsychological test for my insurance company?
Page 13
ImPACT Workshops: Helpful Links and References
Helpful Links
Item Peer Reviewed Reference Articles ImPACT Abstracts ImPACTs Client Resource Center ImCATImPACT Concussion Awareness Tool app ImPACTs Mobile Customer Center app ImPACTs Facebook Page ImPACTs Best Practices ACSM Position Statement on Concussions AMSSMs Position Statement on Concussions CDCs Heads Up Concussion Program NATAs Concussion Position Statement NCAA Concussion Awareness NFHS Concussion in Sports Vienna Concussion Guidelines
Description A list of ImPACTs Peer Reviewed References A list of ImPACT Abstracts A wealth of information from downloadable forms to helpful links.
www.impacttest.com/References.pdf
Link http://impacttest.com/imcat
This free app was developed to educate athletes, parents, teachers and coaches about common signs and symptoms of concussions. Like us on Facebook for updates and news. For Schools and Teams
www.impacttest.com/pdf/7BImPACTAbstractspd f.pdf http://impacttest.com/resources client password: ImClient2011 http://itunes.apple.com/us/app/impact-mobilecustomer-center/id555073365
With this free app for iPhone, iPad and iPod Touch, ImPACTs customers can access their account from an iOS device.
Revised consensus statement better guides team physicians in concussion management
https://www.facebook.com/pages/ImPACT-TestConcussion-Management-Program-forAthletes/172173736183751 https://www.impacttest.com/pdf/improtocol.pdf http://www.acsm.org/about-acsm/mediaroom/news-releases/2011/11/16/same-dayreturn-to-play-no-longer-an-option-forconcussed-athletes http://www.amssm.org/MemberFiles/TPCCState ment2006.pdf http://www.cdc.gov/concussion/headsup/ http://www.nata.org/sites/default/files/MgmtOf SportRelatedConcussion.pdf http://www.ncaa.org/wps/wcm/connect/public /NCAA/Health+and+Safety/Concussion+homepa ge/Concussion+Landing+Page http://www.nfhslearn.com/electivedetail.aspx?co urseid=15000 www.impacttest.com/pdf/7CViennaConcussionin Sportpdf.pdf
Concussion (Mild Traumatic Brain Injury) and the Team Physician: A Consensus Statement* The Centers for Disease Control and Prevention is a great resource to gather additional information regarding concussions. National Athletic Trainers Association Position Statement: Management of SportRelated Concussion Direct link to the NCAA Concussion Awareness Website E-Learning Course for High School Coaches
Summary and Agreement State of the 1st International Symposium on Concussion in Sport, Vienna 2001

345 B-1 ImPACT Billing VOD - Podell 55461

Încărcat de

Informații document

Descriere originală:

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

345 B-1 ImPACT Billing VOD - Podell 55461

Încărcat de

Drepturi de autor:

Formate disponibile

B-1 ImPACT Billing Info Table of Contents

Webinar: Title: Speaker:

B-1 (Intermediate) ImPACT Billing Kenneth Podell, PhD

B-1 ImPACT Billing Section 1: Bio

Billing with ImPACT Webinar Speaker: Kenneth Podell, PhD

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

Billing Through Insurance Companies for ImPACT

Kenneth Podell, Ph.D., FACPN

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

CMS - Centers for Medicare & Medicaid Services

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

ICD-9/10 (International Statistical Classification of Diseases)

ICD-9 Grouped by systems

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

Used in determining reimbursement fee Based upon (in order of complexity):

Malpractice insurance for that procedure (4%)

CMS RVU Values

Code 96116 96118 96119 96120

RVU 1.86 1.86 0.55 0.51

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

CPT Code Definitions

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

CPT Codes - Tips

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

CPT Billing Tip

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

Requires general supervision. Psychologist or physician must be available to the technician.

Is for face-to-face testing time only.

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

Billing Multiple CPT Codes On The Same Day

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

Coding Tip (AMA CPT Assistant, November, 2006)

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

Coding Tip (AMA CPT Assistant, November, 2006)

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

Neurobehavioral Status Exam - 2010 2011

Physician Fee Schedule Search

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

Documentation Crossing your Ts and Dotting Your Is

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

Guide to ImPACT Billing

B-1 ImPACT Billing Section 2: Slides

ICD 9 Diagnosis Codes