Billing Guide

Billing Guide for Psychological Screening and Testing

Connected Mind has assembled a billing guide to help you with the latest codes related to psychological screening and testing in your practice.

It includes codes, definitions, and guidelines, along with examples and sample documentation.

Billing can be divided into sections.

1st determination in test administration is whether the patient has been screened or tested.

Screening

• If patient is negative for all conditions it is considered a screening.

• Negative means the screening is all green. No color at all.

• Negative in the portal states that No Conditions are Triggered.

• Negative can also mean one condition is triggered and it is negative.

• Screening is billed as 96127 with 3 units and a modifier 59.

• Each unit is a condition, even though we screen for 6 conditions Medicare limits the number of conditions to 2.

• MA should hand tablet to patient. If for some reason the doctor hands the tablet to the patient the screening code is 96136

Testing

• If two conditions are triggered (positive or negative) it is considered testing.

• Testing is billed as 96138 with a modifier of 59.

• If one condition (or more) is positive then the doctor can do a report and interpretation.

• Since you cannot bill for screening and a report and interpretation together – if one condition or more is positive you do not bill for test or screening administration.

Reporting & Interpretation

• Reporting & Interpretation is billed as 96130.

• Can be billed with 96138 or by itself.

• Follow documentation or claim will be denied.

Tips

• MA should handle the documentation for the test administration or screening.

• Doctor must handles the documentation for reporting and interpretation.

• Spirit of the documentation is that services performed as part of the E&M must be clearly separate and distinct from the services billed as part of the mental health screening/testing and reporting.

• No double dipping!