Neurology & Pain Management Coding Alert

Question: What is the correct way to bill for a mini-mental status examination (MMSE)? A neurobehavioral status exam (96115) is billed in one-hour units, which is longer than we take for an MMSE, but it is the only code that seems appropriate.

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Answer: Carriers do not believe that the work involved or the time spent on an MMSE is sufficient to meet the requirements for 96115 (neurobehavioral status exam [clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, memory, visual spatial abilities, language functions, planning] with interpretation and report, per hour). According to the AMA July 1996 CPT Assistant, to bill for 96115 the neurologist must perform a clinical evaluation of memory, attention/ concentration, motor speed and strength, speed of mental processing, language functions, visual-spatial abilities, planning and judgment, etc. The evaluation should also include hypothesis testing Lurian methodology, expanded mental status Milestone Screen, with interpretation and interview, and selected items from formal psychological tests. He or she then interprets the findings, formulates a diagnostic impression, and makes treatment recommendations.

A neurologist performing an MMSE a quick way to evaluate cognitive function and screen for dementia or monitor its progression does not involve all of the work described above.

In addition, several Medicare local medical review policies state that the Folstein mini-mental exam (or similar test) is not separately reimbursable by Medicare, because it is included in the clinical interview.

Brief mental status exams such as the MMSE would be included in whatever evaluation and management service (99211-99215) is performed for that session.