Getting reimbursed: Continued preparation for January's testing code changes - APA Services, Inc.

 
Getting reimbursed: Continued preparation for January's testing code changes - APA Services, Inc.
Getting reimbursed:
Continued
preparation for
January’s testing
code changes
                      Presented December 5, 2018 by
                       Antonio E. Puente, PhD
                       Neil H. Pliskin, PhD
                       Diane Pedulla, JD
                                                             ©2018 APA Practice Organization
                            CPT Copyright 2017 American Medical Association. All rights reserved.
                            CPT® is a registered trademark of the American Medical Association.
Getting reimbursed: Continued preparation for January's testing code changes - APA Services, Inc.
Objectives
 Review the new testing codes and definitions

 Walk   through how to crosswalk from the old codes to the new
 ones
 Introduce the new RVUs and payment structure

 Apply the new codes using practical examples

 Discuss how to document your work

 Address “frequently asked questions”

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                      ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Getting reimbursed: Continued preparation for January's testing code changes - APA Services, Inc.
New Testing Code Structure:
Base Code for Testing Evaluation Services

     Preservice                             Intraservice                   Postservice
      Work                                      Work                       Work

 Preliminary Test Selection              Interpretation of Tests     Transcription of Report
 Record Review                           Integration                 Report Distribution
 Call to ascertain referral Q            Clinical Decision Making    Arrangement of Referrals
                                         Diagnosis and Tx Planning
                                         Creation of Report
                                         Interactive Feedback
                                                                                                               3
                                ©2018 APA Practice Organization        Promoting and supporting practicing psychologists
Getting reimbursed: Continued preparation for January's testing code changes - APA Services, Inc.
New Testing Code Structure

BASE CODE         Preservice                    Intraservice     Postservice
(Used Once)         Work                            Work         Work

ADD-ON CODE       Preservice                    Intraservice
                                                                  Postservice
(Possibly used      Work                           Work
                                                                  Work
multiple times)

                                                                                                                        4
                               ©2018 APA Practice Organization                  Promoting and supporting practicing psychologists
New Testing Code Family
Thirteen new CPT codes that describe developmental/behavioral screening and testing services and psychological & neuropsychological testing services.

                                                                                                                                                5
Psychological Testing Services

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                                                                          6
                                 Promoting and supporting practicing psychologists
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.

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                          ©2018 APA Practice Organization    Promoting and supporting practicing psychologists
Existing vs. 2019 Psychological Testing Codes
        90791                              96101                                                                            96102
      Psychiatric
                         Psychological testing per hour                                                            Psychological testing
 Diagnostic Evaluation
                         psychologist's or physician’s time                                                      per hour technician time

       90791                           96136                                     96130                                        96138
     Psychiatric                  Psychological or                          Psychological
     Diagnostic               Neuropsychological Test                     Testing Evaluation,               Psychological or Neuropsychological
     Evaluation               Admin/Data Gathering                             first hour                   Test Admin/Data Gathering by
                               by Physician or other                                                        Technician, first 30 mins
 No Change for 2019            QHP, first 30 minutes

                                     + 96137                                    + 96131
                                 Psychological or                           Psychological                                 + 96139
                             Neuropsychological Test                      Testing Evaluation,              Psychological or Neuropsychological
                             Admin/Data Gathering by                       each addt’l hour                Test Admin/Data Gathering by
                             Physician or other QHP,                                                       Technician, each addt’l 30 mins
                              each addt’l 30 minutes

                         CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.              8

                                        ©2018 APA Practice Organization                                        Promoting and supporting practicing psychologists
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)

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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)

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                  ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Psychological Testing                       Psychological Testing Evaluation Services
                          By Psychologist or Physician                               By Professional

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

                                                                               Psychological testing evaluation services by
                                                                               physician or other qualified health care
                                                                               professional, including integration of
 Psychological                                                                 patient data, interpretation of
  Testing and                                                      96130*      standardized test results and clinical data,
                                                                               clinical decision making, treatment
   Scoring &                                                                   planning and report and interactive
                             Psychological testing (includes
  Evaluation                 psychodiagnostic assessment of                    feedback to the patient, family member(s)
       BY                    emotionality, intellectual abilities,             or caregiver(s), when performed; first hour
PROFESSIONAL                 personality and psychopathology, e.g.,
   Crosswalk      96101
                             MMPI, Rorschach, WAIS), per hour of               each additional hour (List separately in
                             the psychologist's or physician's time, 96131*    addition to code for primary procedure)
                             both face-to-face time administering
                             tests to the patient and time                    Test Administration and Scoring
                             interpreting these test results and                      By Professional
                             preparing the report                              Psychological or neuropsychological test
                                                                               administration and scoring by physician or
                                                                   96136**     other qualified health care professional,
                                                                               two or more tests, any method, first 30
                                                                               minutes
                                                                               each additional 30 minutes (List separately
                                                                   96137**
                                                                               in addition to code for primary procedure)
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                       ©2018 APA Practice Organization                                  Promoting and supporting practicing psychologists
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

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

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                  ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Psychological Testing                              Psychological Testing Evaluation Services
                              By Psychologist or Physician                                      By Professional

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

                                                                                         Psychological testing evaluation services by
                                                                                         physician or other qualified health care
                                                                                         professional, including integration of patient
                                                                                         data, interpretation of standardized test
 Psychological                                                             96130*        results and clinical data, clinical decision
                                                                                         making, treatment planning and report and
  Testing and                                                                            interactive feedback to the patient, family
                                 Psychological testing (includes
   Scoring By                    psychodiagnostic assessment of                          member(s) or caregiver(s), when performed;
  Technician                     emotionality, intellectual abilities,                   first hour
 & Evaluation                    personality and psychopathology, e.g.,
By Professional    96101
                                 MMPI, Rorschach, WAIS), per hour of       96131*
                                                                                         each additional hour (List separately in
                                 the psychologist's or physician's time,                 addition to code for primary procedure)
   Crosswalk                     both face-to-face time administering
                                                                                        Test Administration and Scoring
                                 tests to the patient and time
                                 interpreting these test results and                            By Technician
                                 preparing the report
                                                                                         Psychological or neuropsychological test
                                                                           96138         administration and scoring by technician, two
                                                                                         or more tests, any method; first 30 minutes

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

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Neuropsychological Testing Services

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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

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

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                     ©2018 APA Practice Organization     Promoting and supporting practicing psychologists
Neurobehavioral Status Exam
  2018
                                                               2019
  CPT®               2018 CPT® Descriptor                                2019 CPT® Descriptor
                                                            CPT® Code
  Code

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

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

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        ©2018 APA Practice Organization                                 Promoting and supporting practicing psychologists
Existing vs. 2019 Neuropsychological Testing Codes

       96116                             96118                                                                                             96119
  Neurobehavioral            Neuropsychological testing                                                                          Neuropsychological testing
    Status Exam              per hour psychologist's or                                                                                  per hour
                             physician's time                                                                                         technician time

        96116                           96136                                                         96132                                        96138
Neurobehavioral          Psychological or Neuropsychological                                  Neuropsychological                         Psychological or
Status Exam per hour    Test Admin/Data Gathering by Physician                                Testing Evaluation,                        Neuropsychological Test
physician or other           or other QHP, first 30 minutes                                        first hour                            Admin/Data Gathering
QHP’s time                                                                                                                               by Technician, first 30 mins

        + 96121                        + 96137                                                   + 96133
Neurobehavioral          Psychological or Neuropsychological                               Neuropsychological                                     + 96139
Status Exam each        Test Admin/Data Gathering by Physician                             Testing Evaluation,                     Psychological or Neuropsychological
addt’l hour physician    or other QHP, each addt’l 30 minutes                               each addt’l hour                       Test Admin/Data Gathering by
or other QHP’s time                                                                                                                Technician, each addt’l 30 mins

                            CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.                              17
                                            ©2018 APA Practice Organization                                                       Promoting and supporting practicing psychologists
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
✚96133         each additional hour (List separately in addition to code for
               primary procedure)

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                     ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
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
 ✚96137         each additional 30 minutes (List separately in
                addition to code for primary procedure)

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                    ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Neuropsychological Testing                         Neuropsychological Testing Evaluation Services
Neuropsychological          By Psychologist or Physician                                     By Professional
Testing and Scoring &    2018
                                                                                 2019
                         CPT®         2018 CPT® Descriptor                                        2019 CPT® Descriptor
Evaluation Services      Code
                                                                              CPT® Code

by Professional                                                                                   Neuropsychological testing evaluation
Crosswalk                                                                                         services by physician or other qualified
                                                                                                  health care professional, including
                                                                                                  integration of patient data, interpretation
                                                                    96132*                        of standardized test results and clinical
                                                                                                  data, clinical decision making, treatment
                                  Neuropsychological testing                                      planning and report and interactive
                                  (eg, Halstead-Reitan                                            feedback to the patient, family member(s)
                                  Neuropsychological Battery,                                     or caregiver(s), when performed; first hour
                                  Wechsler Memory Scales and
                                  Wisconsin Card Sorting Test),                                              each additional hour (List
                        96118     per hour of the psychologist's    96133*                                   separately in addition to code
                                  or physician's time, both face-                                 for        primary procedure)
                                  to-face time administering                              Test Administration and Scoring
                                  tests to the patient and time                                  By Professional
                                  interpreting these test results
                                  and preparing the report                                        Psychological or neuropsychological test
                                                                                                  administration and scoring by physician or
                                                                    96136**                       other qualified health care professional,
                                                                                                  two or more tests, any method, first 30
                                                                                                  minutes
                                                                                                             each additional 30 minutes (List
                                                                    96137**                                  separately in addition to code
                                                                                                  for        primary procedure)
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                          ©2018 APA Practice Organization                                          Promoting and supporting practicing psychologists
Neuropsychological Testing & 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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                  ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Technician Administered                           Neuropsychological Testing Evaluation Services
                              Neuropsychological Testing                                       By Professional

                        2018
                                                                               2019
Neuropsychological      CPT®          2018 CPT® Descriptor
                                                                            CPT® Code
                                                                                                2019 CPT® Descriptor
                        Code
Testing and Scoring
  by Technician &                                                                               Neuropsychological testing evaluation services
Evaluation Services                                                                             by physician or other qualified health care
                                                                                                professional, including integration of patient
  by Professional                                                 96132*
                                                                                                data, interpretation of standardized test results
                                                                                                and clinical data, clinical decision making,
     Crosswalk                                                                                  treatment planning and report and interactive
                                                                                                feedback to the patient, family member(s) or
                                  Neuropsychological testing                                    caregiver(s), when performed; first hour
                                  (e.g., Halstead-Reitan
                                  Neuropsychological Battery,
                                  Wechsler Memory Scales and                                               each additional hour (List
                                  Wisconsin Card Sorting Test),   96133*                                   separately in addition to code for
                      96119
                                  with qualified health care                                               primary procedure)
                                  professional interpretation
                                  and report, administered by                           Test Administration and Scoring
                                  technician, per hour of                                       by Technician
                                  technician time, face-to-face
                                                                                                Psychological or neuropsychological test
                                                                  96138**                       administration and scoring by technician, two
                                                                                                or more tests, any method; first 30 minutes

                                                                                                           each additional 30 minutes (List
                                                                  96139**                                  separately in addition to code for
                                                                                                           primary procedure)
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                          ©2018 APA Practice Organization                                       Promoting and supporting practicing psychologists
CPT Time Rule
For time-based codes, the CPT code set states that the following standards shall apply to
time measurement:
A unit of time is attained when the mid-point is passed.

This means:
 A minimum of 16 minutes & maximum of 30 minutes must be provided for 30-minute codes
(Two 30-minute units can be billed when 46-60 minutes of service is provided)

 A minimum of 31 minutes & maximum of 60 minutes must be provided for 60-minute codes
(Two 60-minute units can be billed when 91-120 minutes of service is provided)

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                              ©2018 APA Practice Organization       Promoting and supporting practicing psychologists
CPT Time Rule – Example

   When performing a neurobehavioral exam, the first hour of service is
    billed with CPT® code 96116.
    However, if the service is not complete in one hour, the first unit of
    the add-on code 96121 may be used if the neuropsychologist
    performs at least an additional 31 minutes of work.

These rules apply to all time-based codes in the new code set;
however, it is important to pay close attention to the units of time stated in each code descriptor as they vary from 30
minutes to 1 hour.

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                                        ©2018 APA Practice Organization                     Promoting and supporting practicing psychologists
Single Psychological or Neuropsychological
Automated Testing & Result

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                  ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Existing vs. 2019 Automated Test via
Electronic Platform
                96103                          96120
            Psychological               Neuropsychological
               testing                        testing
            administered                  administered
            by computer                    by computer

                           96146
                      Psychological or
              Neuropsychological Test Admin,
               Single Automated Instrument

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                 ©2018 APA Practice Organization             Promoting and supporting practicing psychologists
Automated Testing and Result

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

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                  ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Crosswalk for 2019 Computerized Test CPT® Codes
   Psychological & Neuropsychological Testing                           Single Psychological or Neuropsychological
                  By Computer                                             Automated Test with Automated Result

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

            Psychological testing (includes
            psychodiagnostic assessment of
            emotionality, intellectual abilities,
96103       personality and psychopathology, e.g.,
            MMPI), administered by a computer, with                               Psychological or neuropsychological test
            qualified health care professional                                    administration, with single automated
            interpretation and report                             96146
                                                                                  instrument via electronic platform, with
                                                                                  automated result only
            Neuropsychological testing (e.g., Wisconsin
            Card Sorting Test), administered by a
96120
            computer, with qualified health care
            professional interpretation and report
                                                                                                                                      28
                                    ©2018 APA Practice Organization                           Promoting and supporting practicing psychologists
Clinical Decision Making

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                  ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Clinical Decision Making = Cognitive Work

    Physicians highly attuned to capturing and quantifying the cognitive work
    that goes into medical and clinical decision making
   This is work we take for granted but occurs throughout the evaluation
    process.
   The ability to accurately and appropriately document our cognitive work
    will be important for psychologists in the new testing code structure

                                                                                                        30
                             ©2018 APA Practice Organization    Promoting and supporting practicing psychologists
The Psychologist Engages in Clinical Decision Making

   The psychologist determines how the patient is responding throughout the
    psychological and neuropsychological testing process.
    Examples of intra-session clinical decision making:
    Level of functioning
    Level of impairment
    Nature of symptoms
    Emotional/behavioral response
    Level of literacy
    Level of language proficiency and/or acculturation
    Isn’t providing valid data
    Requires higher level or more nuanced tests for accurate diagnosis

**This Is especially important to document when using technicians**
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                                     ©2018 APA Practice Organization      Promoting and supporting practicing psychologists
Documenting Your Work

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                  ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Coding and Documentation

    It is recommended that Testing Evaluation Services (96130-96133) and Test
    Administration and Scoring services (96136-96139) be documented in a
    table within the report.
    We suggest listing dates and total times for each activity (including
    scoring and clinical decision making), as well as a separate log sheet
    detailing start/stop times in the clinical chart.

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                              ©2018 APA Practice Organization      Promoting and supporting practicing psychologists
Coding and Documentation

    When a service is spread out over multiple visits, it is recommended that
     all codes be listed by date/service and billed together on the last date of
     service when the evaluation process is completed.
    A base code should only be submitted for the first unit of service of the
    evaluation process, and only add-on codes be used to capture the
    services provided during subsequent days of service.
   Bill separate interactive feedback session using an add-on code (either
    96131 or 96133)

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                              ©2018 APA Practice Organization     Promoting and supporting practicing psychologists
One Way to Document Clinical Decision Making
     Professional Psychological/Neuropsychological
                                                                            Start Time   Stop Time              Total Units
              Testing Evaluation Services

Intra-Session Clinical Decision Making-
 referral review/test selection:
 tech consult/test review/modification:
 tech consult/test review/modification:
 patient limitation management:
 patient behavior management:
 patient symptom monitoring:
Face-to-Face Interpretive Feedback:

Record Review/Integration/Report
Generation:

                                                                                                                                        35
                                          ©2018 APA Practice Organization                       Promoting and supporting practicing psychologists
Transparency and comprehensiveness in
documentation is the key!

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            ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
2019 Non-Facility RVUs and Payment Structure

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                   ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Three (3) Components of a Total Relative Value Unit
                     (RVU)

Total RVU = Cognitive Work RVU + Practice Expense
    RVU + Professional Liability Insurance RVU

     The Total RVUs are then multiplied by a geographic price index.

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                      ©2018 APA Practice Organization       Promoting and supporting practicing psychologists
2019 Psychological and Neuropsychological Testing CPT® Codes & Total RVUs
           CPT Code                                              RVUs
           Neurobehavioral Status Exam
                  96116           First Hour                          2.70
                  ✚96121            Each additional hour              2.32
           Test Evaluation Services
                   96130:
            Psychological Testing First hour                          3.30
             Evaluation Services
                  ✚96131            Each additional hour              2.51
                  96132:
            Neuropsychological
                                    First hour                        3.71
            testing evaluation
                  services
                  ✚96133            Each additional hour              2.83

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                               ©2018 APA Practice Organization    Promoting and supporting practicing psychologists
2019 Psychological & Neuropsychological Testing CPT® Codes & Total RVUs,
cont.

          CPT Code                                               RVUs
          Test Administration and Scoring
          By Professional
                  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

                                 Single automated instrument
                  96146          via electronic platform, with        0.06
                                 automated result only

                                                                                                          40
                                                                  Promoting and supporting practicing psychologists
How to Use the 2019 Non-Facility RVUs

 The Conversion Factor will vary by geographic location.

 2019 Conversion Factor is approximately $36.0391.

 To determine the specific dollar amount per unit of a particular
 code, multiply the Total Non-Facility RVU value by the
 Conversion Factor.
 Ex. for 1 hour of 96116, 2.70 x $36.0391 = $97.31.

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                        ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
A note about Medicare’s Facility Fee Reduction

    As part of a trend since 2015, CMS is reducing valuations for facility-based
    services, especially in hospitals, across all disciplines. This decision is
    unrelated to APA’s CPT/RUC effort and it is not meant to target
    psychological/neuropsychological testing services.
    Since many psychologists and technicians are salaried employees at
    hospitals and facilities, this is not a direct payment reduction. Rather, it’s a
    reduction to the fees paid directly to the facilities to cover overhead
    charges and administrative costs.
    If this situation applies to you and you’d like additional information, please
    contact the APA Practice Organization.

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                               ©2018 APA Practice Organization       Promoting and supporting practicing psychologists
Applying the New Codes Using Practical
Examples
                                                                                          43
                ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Clinical Example 1:
Pediatric ADHD Assessment
Psychiatric Diagnostic Interview + 3 hours of psychologist testing + 3 hours of professional evaluation
services
                                   Code                 Units                                                             RVU
   Diagnostic Interview           90791                (1 unit@ 3.89)                                                    3.89
Test Administration/Data Gathering By Psychologist
 First 30 minutes       96136     (Base Code; 1 unit@ 1.33)                                                              1.33
 Each additional 30 min 96137     (Add-on; 5 units@ 1.23)                                                                6.15
Psychological Testing Evaluation (Professional) Services
 Hour 1                  96130      (Base Code ; 1 unit@ 3.30)                                                           3.30
 Hours 2 & 3             96131      (Add-on; 2 units@ 2.51)                                                              5.02
Total RVUs                                                                                                                19.69

                           CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.           44
                                      ©2018 APA Practice Organization                                         Promoting and supporting practicing psychologists
Clinical Example 2:
Adult with major depression and psychotic features
Diagnostic Interview + 3 hours of technician testing + 3 hours of professional evaluation services

                                 Code                                                                                   RVU
   Diagnostic Interview         90791                 (1 unit@3.89)                                                    3.89
  Test Administration/Data Gathering by Technician
   First 30 minutes       96138      (Base Code; 1 unit@ 1.08)                                                         1.08
   Each additional 30 min 96139      (Add-on; 5 units@ 1.08)                                                           5.40
   Psychological Testing Evaluation (Professional) Services
  Hour 1                  96130      (Base Code ; 1 unit@ 3.30)                                                        3.30
  Hours 2 & 3             96131      (Add-on; 2 units@ 2.51)                                                           5.02
 Total RVUs                                                                                                             18.69

                           CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.      45
                                  ©2018 APA Practice Organization                                        Promoting and supporting practicing psychologists
Clinical Example 3:
MDD+ Psychosis Evaluation with Combined QHP and Technician-Administered
Assessment: Diagnostic Interview+ 2 hours of technician testing + 2 hours of psychologist
administered testing + 2 hours of professional evaluation services
                                            Code                                                                        RVU
        Diagnostic Interview               90791 (1 unit@ 3.89)                                                        3.89
     Test Administration/Data Gathering Psychologist
      First 30 minutes               96136 (Base Code; 1 unit@ 1.33)                                                   1.33
      Each additional 30 minutes     96137 (Add-on; 3 units@ 1.23)                                                     3.69
        Testing Administration/Data Gathering By Technician
        First 30 minutes             96138 (Base Code; 1 unit@1.08)                                                    1.08
        Each additional 30 minutes 96139 (Add-on; 3 units@1.08)                                                        3.24
     Testing Evaluation Services By QHP
      Hour 1                         96130 (Base Code ; 1 unit@ 3.30)                                                  3.30
      Hour 2                         96131 (Add-on ; 1 unit@2.51)                                                      2.51
     Total RVUs                                                                                                         19.04
                                                                                                                                                             46
                           CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.
                                            ©2018 APA Practice Organization                                          Promoting and supporting practicing psychologists
Clinical Example 4:
Differential Diagnosis of Memory Loss/Early Alzheimer’s Disease
2 hours NSE + 4 hours of neuropsychologist testing + 2 hours of professional evaluation services

                                      Code                                                                                    RVU
    Clinical Interview/Neurobehavioral Status Examination (NSE)
     Hour 1                     96116 (Base Code; 1 unit@ 2.70)                                                              2.70
     Each additional hour       96121 (Add-on; 1 unit@ 2.32)                                                                 2.32
     Test Administration/Data Gathering Psychologist
     First 30 minutes           96136(Base Code; 1 unit@ 1.33)                                                               1.33
     Each additional 30 min     96137 (Add-on; 7 units@ 1.23)                                                                8.61
     Neuropsychological Testing Evaluation (Professional) Services
     Hour 1                     96132 (Base Code; 1 unit@ 3.71)                                                              3.71
     Hour 2                     96133 (Add-on; 1 unit@ 2.83)                                                                 2.83
    Total RVUs                                                                                                                21.5
                                                                                                                                                           47
                          CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.
                                         ©2018 APA Practice Organization                                           Promoting and supporting practicing psychologists
Clinical Example 5:
Differential Diagnosis of Memory Loss/Early Alzheimer’s Disease
2 hour NSE+ 4 hours of technician testing + 2 hours of professional evaluation services
                                    Code                                                                                   RVU
       Clinical Interview/Neurobehavioral Status Examination (NSE)
   Hour 1                     96116 (Base Code; 1 unit@ 2.70)                                                             2.70
   Each additional hour       96121 (Add-on; 1 unit@ 2.32)                                                                2.32
   Test Administration/Data Gathering By Technician
   First 30 minutes           96138 (Base Code; 1 unit@ 1.08)                                                             1.08
   Each additional 30 min     96139 (Add-on; 7units@ 1.08)                                                                7.56
   Testing Evaluation Services By QHP
   Hour 1                          96132 (Base Code ; 1 unit@ 3.71)                                                       3.71
   Hour 2                          96133 (Add-on ; 1 unit@ 2.83)                                                          2.83
Total RVUs                                                                                                                 20.2

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                     CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.
                                      ©2018 APA Practice Organization                                           Promoting and supporting practicing psychologists
Clinical Example 6:
    Differential Diagnosis of Memory Loss/Early Alzheimer’s Disease
    2 hour NSE+ 2 hours of technician testing + 2 hours of neuropsychologist testing + 2 hours of professional
    evaluation services              Code                                                       RVU
    Clinical Interview/Neurobehavioral Status Examination (NSE)
     Hour 1                   96116 (Base Code; 1 unit@ 2.70)                                                                 2.70
     Each additional hour     96121 (Add-on; 1 unit@ 2.32)                                                                    2.32

    Test Administration/Data Gathering Psychologist
     First 30 minutes         96136 (Base Code; 1 unit@ 1.33)                                                                 1.33
     Each additional 30 min 96137 (Add-on; 3 units@ 1.23)                                                                     3.69
     Test Administration/Data Gathering By Technician
     First 30 minutes         96138 (Base Code; 1 unit@ 1.08)                                                                 1.08
     Each additional 30 min    96139 (Add-on; 3units@ 1.08)                                                                   3.24
     Testing Evaluation Services By QHP
     Hour 1                   96132 (Base Code ; 1 unit@ 3.71)                                                                3.71
     Hour 2                   96133 (Add-on ; 1 unit@ 2.83)                                                                   2.83
    Total RVUs                                                                                                                 20.9
                                                                                                                                                               49
                               CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.
                                              ©2018 APA Practice Organization                                          Promoting and supporting practicing psychologists
Clinical Example 7:
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.
                       Code          RVU
 1 Unit                           96146                             0.06

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

                        CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.         50
                                  ©2018 APA Practice Organization                                        Promoting and supporting practicing psychologists
Frequently Asked Questions

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         ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Frequently Asked Questions (FAQs)
    In order to use the Testing Evaluation Services codes (96130-96133), must
    the psychologist first perform Test Administration and Scoring services
    (96136-96139)?
   What about the scenario where you complete the testing but can't meet
    with the family for feedback for a few weeks?
   If I use 96133 for 31 minutes and then on another day do a “cognitive work
    activity” (i.e. test evaluation services) do I add it to the first 96133 or is this
    a separate 96133?
    Can interactive feedback be conducted over the phone or are the codes
    for face-to-face use only?

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                                ©2018 APA Practice Organization       Promoting and supporting practicing psychologists
Frequently Asked Questions (FAQs)

   How should we handle testing cases that are being scheduled or are
    already scheduled for the end of 2018?
   What if we administer only one test? What if it has many subtests like the
    Wechsler Intelligence scales?
    For 96146, do you bill this code twice if you give more than 1 automated
    test?

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                             ©2018 APA Practice Organization    Promoting and supporting practicing psychologists
Additional Questions from the Audience

                                                                                      54
            ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
For more information on CPT codes

   APA Practice Organization: www.apapracticecentral.org
    Click on Reimbursement in the top menu.

   Psychology Coding - CPT and Psychological Service Billing:
    http://psychologycoding.org/

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                                ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Recent articles on this topic

   Up-to-Code article providing guidance on how to use the new codes:
    https://www.apapracticecentral.org/reimbursement/testing-codes/changes
    Up-to-Code: New info on billing for psychological & neuropsychological assessment:
    https://www.apapracticecentral.org/reimbursement/testing-codes/billing-psychological-
    assessment.aspx
    Reimbursing for services- http://www.apapracticecentral.org/update/2018/04-19/cms-
    rulemaking-process.aspx
   Up to code: Your money matters- http://www.apapracticecentral.org/update/2018/02-
    08/money-matters.aspx
    Up to code: What’s a RUC survey?- http://www.apapracticecentral.org/update/2017/05-04/ruc-
    survey.aspx

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                                    ©2018 APA Practice Organization         Promoting and supporting practicing psychologists
Still have questions?
    Join us on December 19th at 12pm EST- for a Question & Answer session
    with Dr. Puente and Dr. Pliskin specifically to address any additional
    questions you may have. A link to register will be sent out as a follow-up to
    this presentation or you can view our News and Events page for the most
    recent information on our webinar series:
    https://www.apapracticecentral.org/news

                                                                                                          57

                                ©2018 APA Practice Organization    Promoting and supporting practicing psychologists
Billing or other problems with private or
government insurance?
The APA Practice Organization assists members with health insurance and managed care
issues involving private and government insurers. The latter includes Medicare, Medicaid
and TRICARE. Issues include billing, contracting, restrictions on care, and parity & HIPAA
compliance. Approaches range from collaborative resolutions with enlightened
companies and agencies -- to complaints to regulators, lobbying federal and state
legislatures, and lawsuits.

For issues with private insurers, contact the APA Practice Organization at
PracticeLegalandRegulatory@apa.org.

For issues with government insurers, contact the APA Practice Organization at
PracticeGovRelations@apa.org.
                                                                                                                    58

                                ©2018 APA Practice Organization              Promoting and supporting practicing psychologists
APA Membership
    At APA, we support our members at every stage of their professional journey.
    Join APA today and get the resources you need to help you develop new skills,
    deepen your knowledge, and strengthen your professional identity.
    APA also serves the field of psychology in varied and important ways. As a
    member, your dues will help support public education programs that raise
    awareness of the value of psychology. You’ll also make possible lobbying
    efforts aimed at increasing funding for science and training, raising
    reimbursement rates for practitioners, and convincing policymakers to apply
    psychological science when addressing critical societal issues.
    Not a member? Now is a great time to become one! Visit https://join.apa.org/
    to join.
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                                ©2018 APA Practice Organization   Promoting and supporting practicing psychologists
Thank you for attending today’s webinar.
A link to today’s recorded webinar will be emailed to all registrants within 48
hours. In addition, the slides and the recording will be available on the APA
Practice Organization website in a few weeks. (www.apapracticecentral.org)
We’d like your feedback on this webinar; with each recording email, there is a
link to a survey. We would appreciate it if you would take the time to fill it out.
Have a great day!

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                               ©2018 APA Practice Organization     Promoting and supporting practicing psychologists
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