Nicole Owings-Fonner: Good afternoon or good
morning depending on where you are. Welcome to today’s webinar on what insurers
need to know about the new psychological and neuropsychological testing codes. This webinar is hosted by the APA Practice
Organization. My name is Nicole Owings-Fonner and I’m a
communications project manager at APA. I will be moderating today’s webinar. This webinar is being recorded. A copy will be emailed within 24 hours to
all participants and to those who registered, but could not join the live presentation. A copy of the slides used during today’s presentation
can be found in the handout section. You can also find PDFs of the code definitions
and all the crosswalks that the presenters will be referencing today. Along with the recording, there will be a
survey with questions. We really encourage you to fill this out so
we can know exactly what we need to provide you. Also, if you have any questions about the
materials and what’s covered in the slides, please include those in the survey and we
will be getting back to everyone with responses as we have them. Our presenters today are Doctors Antonio Puente
and Neil Pliskin. I’m going to go ahead and turn it over to
Doctor Puente to start. Dr. Antonio Puente: Well hello, good to be
with you this webinar. The webinar is intended primarily, though
not exclusively for insurers. Our goal is to partner with our colleagues
here in making sure that everybody on both sides understand the new testing codes and
definition. We are going to walk you through the crosswalk
from the old codes to the new codes, and even though we are not only introducing new numbers,
we’re also introducing new definitions and more importantly new concepts. It’s critical that you appreciate the fact
that we are also introducing different time units, which makes this a very different paradigm. Our goal also is to provide practical examples
and at the end have some very frequently asked questions for you to consider. Next slide. One of the major problems was the issue of
the double dip. Specifically there should be a time when a
professional and technician interact, but in many cases, this is occurring in each and
every unit of episode of activity. As a consequence, this was essentially producing,
if you will, an incorrect billing and interpretation of what we were doing. As a consequence, we had to go back to the
table and re think from the ground up everything involving the testing codes, and hence what
we have here before us today. Next slide please. Our goal is essentially as I said earlier
is to make sure that everybody understands that we were facing the same problems, whether
you were a carrier or you were a provider. The double-dip perception has to do with the
unique work performed when both the professional and the technician end up doing the activities
on the same day. There is a long term misunderstanding of the
face-to-face and non-face-to-face work of both the professional as well as the technician. That needed to be clarified. Many carriers have requested that we bill
on multiple days; some requested that we bill only on one day. This has been confusing. We will provide some guidance has to how to
go about applying these codes and when and how to bill them. Also, a major issue was how do we interpret
a single test versus how do we interpret when we have multiple tests, as well as background
information. The concept of data integration and specifically
how do we engage in clinical decision making, how does a provider end up integrating material
to come up with an understanding of the complexities associated with both psychological and neuro
psychological testing. Historically, we’ve been telling folks when
you provide feedback just envelop it within the testing code. It turns out that was not clear, it was not
provided, in the original concept and we now have specific guidance and how to do the feedback
itself. Finally, the computer screening test, billing
as a psychological, neuropsychological testing turned out to be a serious concern. We have solutions to these, and many of the
other concerns have been raised over the last year years during the life of these codes. Next slide, please. The new testing code structure has essentially
a base code for testing evaluation and it’s basically founded on the concept that there’s
three parts to every activity. Pre-service work, intra-service work, and
the post-service work. Most of us, we understand the intra-service
work, and that includes as you see in the slide anything from interpretation of tests
to interactive feedback, but there’s a pre-service work, as well as a post-service work, and
that is in many ways where some of this becomes a bit of a challenge. Our goal was to make sure that we understood
exactly what was to occur pre, post, as well as intra. Now the next slide provides a very, very important
concept that we want to make sure we all understand. The base code, which is a foundation for everything
that involves the testing includes free, post, and intra-service work. In other words, we select a test, we follow
up etc. The biggest activity of course is the intra-service
work. When we add on to these base codes, in other
words when we add how many additional units of work we’re pursuing and activity, then
we do not want to if you will double dip by adding the pre and the post service work. The pre and post service work, one more time
should only occur when we have a foundational or base code, not when we have the add on
codes. This is not only a new testing code structure,
but a new paradigm for how to code and bill. And with this foundation I’m going to turn
over to my esteemed colleague, Dr. Pliskin, who will go into detail of all the testing
codes. Neil? Dr. Neil Pliskin: Thank you, Dr. Puente. There are three new main sub-sections that
have been added to the section of the CPT codebook entitled Central Nervous System Assessments/Tests,
and 12 new codes have been added. These subsections are assessment of Aphasia
and Cognitive Performance Testing, Developmental/Behavioral Screening and Testing, and Psychological/Neuropsychological
Testing. Next slide. So the addition of the 12 codes to this subsection
allows the reporting of services provided during testing of the cognitive and neurobehavioral
functions of the central nervous system. I want to emphasize very clearly that this
is not a one-to-one crosswalk between the codes that are about to be deleted and the
new codes. These are a new series of codes that is not
a one-to-one crosswalk from the deleted codes. It’s a new sheet of music that this concerto
will be playing on. Next slide. Dr. Antonio Puente: And before you go on,
Neil, let’s make sure that we also realize, it’s not just a bunch of new codes, but a
bunch of new units, so we can’t just translate the same number of units that we have historically
done. Dr. Neil Pliskin: Very good. The terms that we want to make sure are well
defined and understood are listed on this slide. Neurobehavioral status exam is an existing
code and description that we’ll talk about, but in the new code system you’ll now have
something called neuropsychological testing evaluation services and psychological testing
evaluation services. As Dr. Puente has already foreshadowed, there
is now an explicit place to document, sorry… code your interactive feedback, which we’ll
define. Next slide. So the neurobehavioral status exam is a clinical
interview assessment of cognitive functions and behavior. It may include an interview with the patient
and other informants or staff, as well as integration of prior history and other sources
of clinical data with clinical decision making further assessment and/or treatment planning
and report. Next definition. These terms, psychological testing evaluation
services, and neuropsychological testing evaluation services are the services that are uniquely
provided by the qualified healthcare professional. If you’re doing a psychological evaluation
this would typically include professional activities of integration of the patient data
with other sources of clinical data, test interpretation, clinical decision making,
treatment planning and report. And note, included in this code, the testing
evaluation services it may include interactive feedback to the patient, family member, caregiver,
when performed. The evaluation domains for psychological evaluation
may include emotional and interpersonal functioning, intellectual function, thought processes,
personality, and psychopathology. And when you contrast that to neuropsychological
testing evaluation services, the professional activities are still the same. That is integration of patient data, interpretation,
clinical decision making, treatment planning and report. It also includes interactive feedback for
your neuropsychological evaluation. For neuropsychological testing evaluation
services, those domains include intellectual functioning, attention, executive functioning,
language and communication, memory, visual spatial functioning, sensory motor functioning. Note, emotional and personality features,
and adaptive behavior. We’ll go into more detail as this webinar
progresses. Next slide. We’ve talked about it, let’s define it. Interactive feedback: interactive feedback
is used to convey the implications of psychological or neuropsychological test findings and diagnostics
formulation. Based on patient-specific cognitive and emotional
strengths and weaknesses, interactive feedback may include promoting adherence to medical
and/or psychological treatment plans, educating and engaging the patient about his or her
condition to maximize patient collaboration in their care, addressing safety issues, facilitating
psychologically coping, coordinating care, and engaging the patient in planning given
the expected course of illness or condition when performed. This is uniquely a professional services activity,
interactive feedback. Using the professional services codes, this
is how you will code interactive feedback going forward. Next slide. So here’s an overview, and then we’re going
to dig into the details. The overview of the new testing code family
includes neurobehavioral status exam the testing evaluation services, 96130, 96133 and as Dr.
Puente mentioned we’re now dealing with a base code, 96130 and an add on code 96131
for psychological professional testing evaluation services, and you’re using the base code 96132
and the add on code 96133 for your professional testing evaluation services, provided by your
qualified healthcare professional for neuropsychological services. Note, whether you’re talking about the neurobehavioral
status exam and its add-on, 96121 or you’re talking about test evaluation services, whether
it’s psychological or neuropsychological testing evaluation services, those are coded per hour
of service. When you now move to the test administration
and scoring, which has been separated completely from the professional test evaluation services
the units have changed. There are now codes, 96136 the base and 96137
for psychological or neuropsychological test administration and scoring by physician or
other qualified healthcare professional, two or more tests, first 30 minutes, and 96138
and 96139 the base and add on codes for psychological or neuropsychological test administration
and scoring by technician. Again, it has to be two or more tests to use
this code and if it’s less than two tests we have a different code, which we’ll go through
shortly, but it has to be two or more tests, and note first 30 minutes and each additional
30 minutes. Practically, what that means for those of
you that have been getting pre-authorization requests for four hours of neuropsychological
or psychological test administration the units of coding will be completely new for starting
January one, where they will be in half hour units and you can expect both base and add
on codes in add on units. Next slide. Now let’s get into the details. Psychological testing services. As before, there’s been no change to CPT code
90791. If you’re doing a psychological evaluation
and you’re as part of the psychological evaluation you’re conducting a clinical interview a psychiatric
diagnostic evaluation you would use 90791 in conjunction with your psychological testing
services code, and your psychological test administration and scoring codes. This has not changed. Next slide. Here are the changes. Let’s skip this and let’s get into the details. We’ll go back to these kinds of slides. Here is the deeper look at this. For your based code, when a psychologist is
providing a psychological testing evaluation services, they will be using the base code
for their first hour of service, 96130 and the add on code, 96131 for each additional
hour of professional services provided by the qualified healthcare professional engaged
in these professional activities as provided in this code descriptor. Next slide. As every psychologist knows, or most of us
know I should say, we’re a divided group when it comes to test administration and scoring. That is our professional surveys show that
roughly half of all psychologists use technicians and half of all psychologists provide their
own testing. Their own test administration and scoring,
therefore there are separate codes designated for when the psychologist does her or his
own testing. So 96136 is psychological or neuropsychological
test administration and scoring, so note that in this code, we’re not only talking about
the face-to-face test administration, but we’re also talking about non face-to-face
activities scoring by physician or other qualified healthcare professional. Again, the qualifiers. Two or more tests, any method. A frequently asked question is what about
the computer testing code and how do you code computer tests. In the new coding structure it’s any method. So whether it’s paper and pencil, whether
it is handheld, whether it is computer, desktop or laptop, any method that the psychologist
her or himself administers and scores the test, you will use this code, the base code,
96136 for the first 30 minutes. If there is additional testing … Please
go back. If there is additional testing, then that
extends beyond that first half hour, then you will be using, or your psychologist and
other qualified healthcare professionals will be using the add on code 96137. Next slide please. So here’s the crosswalk. Right now until December 31st, you… qualified healthcare professionals doing psychological
testing are using the single code, 96101. This slide illustrates very clearly now the
separation between the testing evaluation services, which are uniquely provided by the
qualified healthcare professional and the test administration and scoring services,
which could be provided by the professional and if it is, then you use the following code
structure. For the first hour of psychological test evaluation
services it will be 96130 and for the base and the add-on will be 96131 for each additional
hour. For the test administration and scoring when
completed by the professional, 96136, first 30 minutes two or more tests any method and
add on code for each additional 30 minutes 96137. So we’re going from a single code 96101 to
multiple codes that provide a more granular appreciation for the services that are being
uniquely provided by in this scenario the professional, but distinguishing between the
testing evaluation services, and the test administration and scoring. Next slide. When the psychological testing and scoring
is done by a technician, there is a separate set of codes; that would be 96138 the base
code, which again is psychological or neuropsychological test administration and scoring by technician. Again, two or more tests, again any method,
and again first 30 minutes. If the testing extends beyond that first 30
minutes, and the technician is administering the test, then each additional 30 minutes
is coded with add on code 96139. Here’s how the crosswalk looks. Very similar. Next slide. And that is 96130 and 131 for your professional
services, and for test administration and non-face to face activities scoring by technician
96138 is the base 96139 is the add-on. Next slide. Here’s several clinical examples. In example one we have a pediatric ADHD psychological
assessment. And for this scenario we have one diagnostic
interview conducted by the qualified healthcare professional, three hours of in this case
for this example I’m a psychologist so I’ll say by psychologist administering tests, and
three hours of the professional evaluation services. Take a look how this will be coded now. The diagnostic interview, as has been the
case all along … by all along I mean currently and it won’t change, diagnostic interview
will be 90791 and that’s not a time based code, so it’s just a single unit. The test administration and the scoring and
data gathering when conducted by the psychologist in this scenario it’s three hours of psychological
testing, the best code is 30 minutes, so the first 30 minutes is 96136 and then the remaining
two and a half hours of psychological testing is coded in half hour units totaling five
units at 96137. Then the formal testing evaluation services
provided by uniquely by the qualified healthcare professional in this example is three hours. Since it’s an hourly code, hour one is code
96130, the base code. Hours two and three are 96131 two units of
add on to cover the three total hours of professional evaluation services. What you can expect when you get these submissions
for an assessment where the psychologist is doing or the qualified healthcare professional
is doing their own testing you can expect five different codes to be submitted. Next slide. Dr. Antonio Puente: And many more units than
historically we’ve been billing. It’s not just a series of new numbers, but
a series of new units. In this particular instance, you can end up
with several different codes and a total of 10 different units billed. Dr. Neil Pliskin: Okay, next slide. Here’s another clinical example. This one is of a psychological evaluation
for an individual with chronic pain. Perhaps this will be for placement of a spinal
cord simulator. There’s lots of different scenarios where
this will take place. The scenario that we’re describing here is
again one diagnostic interview, except this time we have a technician administering the
testing for three hours, and then the same three hours of professional evaluation services. Like the last example, the diagnostic interview
is still coded, single code, 90791, except this time the test administration and scoring
the data gathering is being conducted by the technician so therefore it’s a different set
of codes. The first 30 minutes out of the three hours
of technician testing you’ll use the base code, 96138. For the remaining two and a half hours coded
in half hour units, five units, you’ll use the add on code 96139. As before, the qualified healthcare professional
is providing the test evaluation services, in this case example, it’s three hours of
services, the first hour 96130 is the base code, hours two and three 96131 the add on
code, two units. Finally, third example, next slide. Another very common scenario is where you’ll
have a qualified healthcare professional and a technician both administer tests as part
of the assessment process. In this example we have one diagnostic interview,
two hours of technician testing, two hours of qualified healthcare professional administered
testing, and two hours of professional evaluation services. The numbers don’t line up exactly, but I think
you’ll follow it pretty clearly that the diagnostic interview is again accomplished through the
psychiatric diagnostic interview code, 907, evaluation code 90791. For test administration and scoring services
provided by the psychologist, in this example it’s two hours, so the first 30 minutes, the
base code 96136, which is test administration and scoring, neuropsychological and psychological
test administration and scoring by qualified healthcare professional, first 30 minutes,
and for the remaining one and a half hours of testing coded in 30 minute units, we have
the add on 96137. Since in this scenario the technician also
did some testing, two hours of testing you’re also using 96138 the base for the first 30
minutes and 96139 the add on for the remaining 90 minutes or three units. And then regardless whether it’s the QHP,
who’s doing the testing, test administration and scoring, the technician who’s doing the
test administration and scoring or both on the same patient, testing evaluation services
are uniquely provided by the qualified healthcare professional and that’s two hours of professional
evaluation services, the base code 96130 the add on code, 96131. Dr. Antonio Puente: So we could end up with
seven different new codes and 11 different units of activity. Dr. Neil Pliskin: That’s correct, but at the
same time by looking at the distribution of those codes the carriers will get a much clearer
sense of who’s providing what service and for how long. A lot of the struggles that you alluded to,
Dr. Puente, of what service is being provided by the QHP, what’s being provided by the technician,
what’s a professional service, what’s a data gathering service: now I think with this new
code structure, while it will take some getting used to the number of codes, the granularity
of what are the services being provided will be much clearer. Next slide. Now let’s turn our attention to neuropsychological
testing services. And this will be a familiar structure, because
we just walked through it with the psychological testing services. Here we go. When conducting a clinical interview for an
individual who’s undergoing a neuropsychological evaluation, one would typically conduct a
neurobehavioral status exam, which we previously defined as a clinical interview based assessment
by the physician or other qualified healthcare professional both face to face time and time
interpreting test results and preparing the report, first hour. Conducting the clinical interview and clinical
exam, 96116, which is the same code that we have in place this year for the first hour,
but in the new coding system there’s an add-on code. So 96116 now becomes the base for the first
hour and if the neurobehavioral status exam extends beyond the first hour, then you would
use the add-on code 96121. Next slide. Here’s the crosswalk. For 96116 neurobehavioral status exam, if
it’s just for one hour or up to 31 minutes to an hour, then you’ll use 96116, the base
code. If it extends beyond that first hour, there
will now be an add-on code, 96121. Next slide. This is a snapshot of the neurobehavioral
status exam from the CPT code book, which clearly delineates that the neurobehavioral
status exam involves cognitive services, it can involve test administration in the context
of the clinical interview, and that’s done solely by the physician or qualified healthcare
professional and the interpretation report or automated result is provided uniquely by
the physician or qualified healthcare professional that’s 96116 and 121 the neurobehavioral status
exam. Next. And we’ll skip this slide and dig into the
details instead. For your qualified healthcare professional
providing testing evaluation services, which we have defined several times in this webinar,
the first hour will be 96132. The second and subsequent hours will be coded
with the add on code 96133, so again when your physician or other qualified healthcare
professional engages in uniquely professional activities integration of patient data, interpretation
of standardized test results and clinical data, clinical decision making, treatment
planning, report, and interactive feedback to the patient family member or caregiver
when performed in the first hour 96132 each additional hour add on code 96133. Next slide. And we’ve already defined interactive feedback. I’ll just say that the interactive feedback
should be coded using the add-on code 96133. Since it will be connected to the base code
through the evaluation itself. Next slide. The professional services of 96132 and 96133
and … let me back up. This chart represents all of the professional
services. 96130 and 131 we just finished reviewing,
psychological test evaluation services based in add-on. And 96132 and 133, which we’re talking about
now neuropsychological test evaluation services base and add-on and this chart clearly illustrates
that there are cognitive services associated with this, and there’s interpretation and
report services associated with it, but test administration and scoring are not associated
and included in test evaluation services. That’s now separated out as we’ve been saying. Next slide. When the qualified healthcare professional
is the one administering the tests, 96136 the base, 96137 the add-on, 30 minutes any
method two or more tests. So whether you’re doing psychological or neuropsychological
test administration if it’s the physician or qualified healthcare professional doing
that, you’re going to be using the codes 96136 for the base and 96137 for the add on, 30
minutes each. Next slide. So the crosswalk currently 96118 will be deleted
and will be replaced by the professional neuropsychological testing evaluation services, 96132 and 133
and if the professional is going their own testing half hour units 30 minute units 96136
and 137. Next slide. As we’ve said, when the technician is administering
the testing under the supervision of course of the qualified healthcare professional then
you would use the new codes for test administrating and scoring by technician 96138 for the first
30 minutes, 96139 for each additional 30 minutes, any method two or more test. Next slide. The crosswalk will be familiar now. 96119, which will be deleted and replaced
with 96132 and 133 for professional services provided, testing evaluation services, and
if it’s a technician administering the testing and completing the scoring 96138, 96139 30
minutes base and add on. Next slide. Here’s your clinical examples. Here’s a two hour neurobehavioral status exam,
four hours of psychologists in this case doing their testing own testing, and two hours of
professional services. So note, this is a two hour neurobehavioral
status exam, hence 96116 is your base and the second hour is now coded 96121 the new
add on. For test administration and scoring in this
case, in this example by a psychologist or other qualified healthcare professional we
said four hours of testing so the first 30 minutes is 96136 and then the remainder of
the time in half hour units, which is comprising seven units in this example 96137 and then
the distinctly separate neuropsychological testing evaluation services, two hours in
this case base code for the first hour 96132 add on code for the second hour 96133. Next please. Dr. Antonio Puente: And Neil, before you go
on, let’s emphasize that we are not changing the total amount of hours with these activities. In an effort to be granular and clear about
exactly what we are doing, we are just simply breaking things down in such a way that everybody
has a very clear vision of how many things are being done and who’s doing them. In this case, we have six different units
and different codes, excuse me, and a total of approximately 12 different units. That is done not to change the scope of practice,
just to clarify the practice itself. Dr. Neil Pliskin: Next slide. Okay, and these other examples will be familiar
to you. We say a 46 year old male with a history of
coronary artery disease with reported symptoms of memory loss, anxiety and depression, this
is a one hour neurobehavioral status exam four hours of technician testing, which this
time will be the first 30 minutes 96138 and then each additional 30 minutes totaling seven
units 96139, but the testing evaluation services by the qualified healthcare professional will
still remain 96132 for the first hour, and 96133 the add on for the second hour. Next slide. And just to highlight the point, and I’m not
going to dig into the details here, but to highlight the point that again, it’s typical
practice for both the technician and a psychologist to engage in test administration and scoring
services, and so please expect to receive a documentation that reflects different test
administration by the qualified healthcare professional versus test administration and
scoring by the technician. Next slide. This just illustrates the test administration
and scoring doesn’t involve the cognitive services, doesn’t involve the interpretation
in report or automated result, it’s uniquely related to test administration and scoring
only. Next. Finally, what happens if it’s not two or more
tests if it’s a single test? Next slide. Currently, the codes that are about to be
deleted, 96103, and 96120 are neuropsychological testing administered by computer. In 2019 the code will be 96146 psychological
or neuropsychological test administration single automated instrument with automated
result. Next slide. That’s the code. Next slide. So the crosswalk will be when it involves
a single automated instrument via electronic platform with automated result only the code
to use will be 96146. And here’s the clinical example of this, next
slide. 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. That would be psychological and neuropsychological
test administration, single automated instrument via electronic platform with automated result
only one unit 96146. There is no physician work, just practice
expense in this code. If there are two or more tests that are being
administered that requires testing evaluation services, in other words you can’t just use
psychological or neuropsychological test administration two or more tests without it also being coupled
with the professional test evaluation services. Just a few more slides. Next please. It’s just an automated result, no cognitive
services, no test administration and scoring beyond the single automated test. Next slide. Dr. Puente? Dr. Antonio Puente: As you can see in this
particular slide and the next one, we are presenting for your consideration and understanding
the RVUs associated with each of these new codes. For example 96116, which is an old code, the
RVU is at 2.70; the 130, it’s 3.30. Essentially they’re different codes, different
descriptors and different RVUs. Again, this is for your consideration. These RVUs would determine [inaudible 00:42:33]
as you well know through the different processes associated with the RVU system of the AMA
CPT. The next slide provides additional information
regarding these RVUs and as you can see, some are relatively small. For example the by technician 138 is 1.08
and some are basically as Neil said the practice expense four and 46, which is .06. The goal is to provide information regarding
these RVUs as you develop your own payment policy. Now let’s move onto the next set of, if you
will, the next part of our presentation. We have some questions that we’d like to propose
to you for your consideration and the next slide will provide at least some sampling
of that. Dr. Pliskin, could you take it away? Dr. Neil Pliskin: If both the psychologist
and the technician provide test administration and scoring services during the evaluation. Can both test administration and scoring codes
96136 through 96139 be used to document the time spent by each? The answer is yes, and the clinical examples
that we provided illustrated how both the qualified healthcare professional and the
technician can engage in test administration and scoring services and the same patient. How should we bill for services that take
place over multiple days? This is a complicated question, but it’s typical
for psychologists to provide testing evaluation services, and I say psychologists because
I’m a psychologist, but it’s typical for qualified healthcare professionals who engage in these
services to provide testing evaluation services, and test administration and scoring services
across multiple days of service. This could include multiple testing sessions
with test scoring, it could include non-face to face time engaged in professional services,
it could include interactive feedback sessions. When a service is spread out over multiple
visits it’s our recommendation that all codes be listed by the date in service and billed
together on the last date of service when the evaluation process is completed. Additionally, a base code should only be submitted
for the first unit of service, and only an add-on code should be used to capture the
services provided during subsequent days of service. And finally, what about the scenario where
you complete the testing, but can’t meet with the family for feedback for a few weeks. I think we’ve already said that you would
code that as an add on code, you would not have a new base code for a feedback session
that’s based on an evaluation that took place a period of time earlier. Dr. Antonio Puente: Dr. Pliskin, let me go
back to the second question that was posed in this slide number 50. Let me be clear, how is it that I’m supposed
to bill? Is it that I in the report, and in the billing
sheet provide the different days, but I wait until I have full documentation on the last
day of service to submit the bill? Please explain [inaudible 00:45:58] that because
some of us are not entirely clear when is it that we actually document, and when is
it that we actually bill? Could you please expand on that? Dr. Neil Pliskin: Well, Dr. Puente, I’m aware
that we’re very short on time, and that’s a more complicated question in terms of how
to document all that. So we’ll have to address that in subsequent
communications, but I think the short answer to the question is that all the codes should
be listed by the date and the service. And then billed together on the last date
of service. Dr. Antonio Puente: Thank you. Also, regarding the issue of clinical decision
making, will you be providing or will APA be providing additional information to us
as to how do we document clinical decision making? Dr. Neil Pliskin: Absolutely. That will be forthcoming. Dr. Antonio Puente: Okay, and finally, I wanted
to emphasize on behalf of all of APA Practice Organization how thankful we are that we had
the opportunity to work with the carriers in helping develop these concerns and questions. We also look forward to making sure that you
provide us feedback so we can continue collaborating. A big thank you to the folks at National Academy
of Neuropsychology and our other sister associations that have partnered with us in making this
particular presentation become a reality. But before we begin to wrap it up and turn
it over to Nicole, Neil, you’ve been working on this for a bunch of years now — what’s
your takeaway? How is it that a carrier needs to reconfigure
the new testing codes? It’s not just a bunch of new numbers and definitions,
but it’s a new paradigm. What’s your takeaway to our colleagues in
the carrier industry of what this paradigm means to them? Dr. Neil Pliskin: Well, what I would say is
that it’s a new day and a new set of codes and a new set of units associated with those
codes. I would tell the carriers that they can’t
conceptualize services provided in 2019 the way that they have been documented and billed
for in 2018. It’s a new day, and there will be as an example,
there will be authorization requests for twice the number of units than is typically people
have grown accustom to seeing and approving. I encourage the carriers to look carefully
at each of the codes, at what’s being requested, and to be attuned to the fact that there is
no direct crosswalk from 2018 to 2019. Dr. Antonio Puente: And just for historical
purposes before I turn it over to Nicole, the shift in this paradigm that we’re presenting
was really prompted by CMS realizing that these were highly utilized and valued codes
and they were thinking that we were not necessarily capturing what we were actually doing. And as a consequence a comprehensive study
was done by APA and the sister associations to make sure that we were clear, very clear
what is the activity that is being performed by whom and for how long. This is not meant to change the scope of practice,
this is meant to be granular and clear about the activities that the provider and the technician
does. Dr. Neil Pliskin: And to support that the
APA Practice Organization is working on a model LCD and a user’s guide to help the carriers,
and providers alike understand how to use these codes and the parameters of codes used. Dr. Antonio Puente: And Nicole, would you
tell us a little about the number of things that Dr. Skillings and the Practice Organization
staff have been able to put together to make sure that this transition to the new testing
codes is effective for both providers as well as for carriers? Nicole Owings-Fonner: Yes, thank you to both
of our presenters today. Unfortunately, we are now running over time,
so I encourage you to check out all of the resources that APA Practice Organization on
our website at If you click on reimbursement under the testing
code section you’ll find all of this information and more. If you do have additional questions, please
feel free to contact APA’s Office of Healthcare Financing at [email protected] Additionally, we want to thank you for attending
today’s webinar. Like I said at the beginning, a link to today’s
recorded webinar will be emailed to all of you within 48 hours, and we’d really appreciate
your feedback through that survey. If you have any other questions that weren’t
addressed, please include them in that survey so we can get that important information to
you. Thank you, and have a great day.