neuropsychological testing using CPT® 96116

Hello,
I am contracting for an insurance company and I am seeing a provider bill 96116 for multiple units per day and many days per month for many patients. I am wondering if this is appropriate. I am seeing various definitions for the code and I am struggling to understand exactly what the code entails and how it is billed appropriately. Any assistance is greatly appreciated.
Patti

re: neuropsychological testing using CPT® 96116

A physician should use this code when doing extended neurobehavior exams on patients. Some rules apply:

The code is based on time (per hour). Time taken must be mentioned explicitly in the report.
The code is for an hour of Neurobehavioral testing. The total time is the sum of time taken to administer, to score, and to generate a report. There must be a separately identifiable report. If 31 minutes or more are spent on the service, you can bill 96116. This includes time spent face-to-face with the patient, interpreting test results, and preparing the report. The total time must be mentioned explicitly in the report. The medical record should include all of the following information:
Reason for referral;Tests administered, scoring/interpretation and time involved;
Present evaluation;Diagnosis (or suspected diagnosis that was the basis for the testing if no mental illness was found);Recommendations for interventions, if necessary.

re: neuropsychological testing using CPT® 96116

Thank you very much.

I am concerned about this particular billing.

Would you say it was illogical for one provider to bill this code for the same patient 5 or 6 times a month for several months (up to 12 consecutive months)? For example: on 11/30/11 bill 3 units and 12/5/11 2 units and 12/7/11 2 more units, etc.

re: neuropsychological testing using CPT® 96116

I would say it's a stretch but question is "medical necessity??".
Psychological Tests are not considered medically necessary if:(1)Tests are performed when mental illness is not suspected.
(2) Standardized batteries of tests are performed. Each test performed must be medically necessary. (3) Repeat testing is not required for a diagnosis or continued treatment. (4) Non-specific behaviors which do not indicate the presence of, or change in, a mental illness would not be an acceptable indication for testing. Codes 96101-96118 should not be billed by the treating physician for reading a psychologist's report of the psychological testing results. Such reports are included in the medical decision making of the patient's visit (Evaluation and Management Service). Procedure codes (96101, 96105, 96116, and 96118) are considered Time Based codes. If the testing is done over several days, the testing time including administration, scoring, and interpretation should be combined and reported all on the last date of service.

re: neuropsychological testing using CPT® 96116

Thank you so very much!!

re: neuropsychological testing using CPT® 96116

Good Luck