Medical Billing Forum

General Category => General Questions => Topic started by: K and K Billing on March 14, 2012, 04:56:21 PM

Title: Billing codes for extended time on testing and evaluation
Post by: K and K Billing on March 14, 2012, 04:56:21 PM
I am a billing service for Metal Health providers. A new client and I am wondering how to bill manage care & medicare for specific services that take longer than the one hour on allowed on the CPT code.

The provider's specialty is Neurology - Psychiatry. For the initial intake the code as 99205 but in addition she administers test and evaluation procedures that take an addition two hours. The code for that is 96116 but only allows 1 hour. How do I bill the additional hour needed for the 96116. I I simple list the code a second time, it will probably be rejected as a duplicate.

Any help would be appreciated
Title: Re: Billing codes for extended time on testing and evaluation
Post by: DMK on March 14, 2012, 06:56:06 PM
-25 modifier indicates a separate exam code. Make sure the documentation supports this.  96116 is a code PER HOUR, so you can bill multiple units of this code.  Be sure to multiply the amount charges accordingly.
Title: Re: Billing codes for extended time on testing and evaluation
Post by: PMRNC on March 15, 2012, 08:13:57 AM
many of the mental health carriers out there will not pay for these on the same day. Make sure you verify benefits and get written auth's if they say they allow it, most will only allow 1 unit per day.