Family physicians and coding professionals are frustrated with the confusion surrounding proper reporting of brief mental assessments often performed in an office setting. The evaluation in question is often noted on the patient chart as a mini-mental exam or mini-mental status examination (MMSE).
The reason that this code cant be found is that it doesnt exist, says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Systems Inc., which supports family practice physicians in Broomfield, Colo. When these assessments are conducted by a family physician in his or her office, it is included as part of the evaluation and management (E/M) service. Of course, the performance of a mini-mental exam should be factored in when the appropriate level of E/M code is determined.