Author Topic: neuropsych testing and modifier 59  (Read 1174 times)

dans169

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neuropsych testing and modifier 59
« on: June 10, 2015, 11:44:59 AM »
Greetings,

Our specialty is neuropsychology. My question involves two codes we usually bill on the same DOS.

In the past with BCBS    we have billed either a 96118 (neuropsych testing) and 96120 (neuropsych test admin/w computer) or a 96119 (neuropsych testing by technician)and the 96120 on the same DOS.

Recently, in just the last month the 96120’shave not been paid by BCBS. After a few phone calls and talking with different agents at BCBS, they said there was a recent coding edit that makes the 96120 a mutually exclusive service.

My understanding is this means it cannot be billed in the same DOS as any other procedure.
I wanted to ask though if we could use modifier 59 with either the 96120 or the 96119/96118 and still bill on the same DOS without the code denial. My understanding is the Modifier 59 means the code is a unique and unrelated service.

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/modifier59.pdf

Your thoughts?

If using modifier 59 would work, does the modifier get attached only to the 96120, the 96119/96118 or both?

Thanks so much
Best,
Dan

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Re: neuropsych testing and modifier 59
« Reply #1 on: June 10, 2015, 12:34:11 PM »
I believe the edits were put in April.. I know EMPIRE sent us notice of changes but some of the dx codes won't change until Oct.  Not sure if this will help.  As far as I can see you can't bill for the 96120 on same date.

http://www.empireblue.com/medicalpolicies/guidelines/gl_pw_a053761.htm
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

dans169

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Re: neuropsych testing and modifier 59
« Reply #2 on: June 11, 2015, 10:19:41 AM »
Does anyone have experience using the modifier 59 when billing two codes on the same DOS? If so, do you append it to each code or just 1?

I think I'm going to try to still bill the dual codes on the same day and use the modifier. The problem is I won't know if it has done the trick because the different plan groups are at various stages of implementing this new policy. :-[