Neurology & Pain Management Coding Alert

Continue to bundle mini-mental exams to E/M services

For neurologists who have tried to gain reimbursement--and been denied--for neurobehavioral status exams, CPT 2006 will offer a new code and explanatory text.

Kiss 96115 Goodbye

Come January 1, you-ll no longer have the option to report 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).

For 2006, the AMA will strike 96115 from CPT, explains Antonio E. Puente, PhD, CPT Advisory Committee Representative for the American Psychological Association. The AMA will replace 96115 with new code: 96116 (Neurobehavioral status exam [clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities], per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report).

The rationale: -The AMA and the American Psychological Association believed that 96116 would better represent the evolution of these services,- Puente comments.

End Bundling Concerns With 96116

In addition to the new code, new explanatory text seeks to rectify a previous pattern of coding errors. Under the -Central Nervous System Assessments/Tests- heading, CPT 2006 clarifies: -For mini-mental status examination performed by a physician, see Evaluation and Management service codes.-

Old problem: In the past, practices regularly, but incorrectly, reported 96115 for mini-mental status exams, when the code properly described an in-depth and lengthy evaluation of the patient's thinking, reasoning and judgment, explains Anne M Dunne, RN, MBA, MSCN, practice administrator for South Shore Neurologic Associates, P.C./Brookhaven MRI, in Bay Shore, NY. A mini-mental exam, in contrast, is a summary test that takes less than 15 minutes to perform and interpret, and which you should consider a part of any E/M service.

In response to these frequent errors and what many carriers perceived as abusive billing, most payers have stopped reimbursing for 96115--regardless of how well the physician documented the service. In fact, the National Correct Coding Initiative (NCCI) bundled 96115 into nearly all E/M codes, thereby disallowing separate payment. This created an unfair situation for neurologists providing full mental status exams, because these services could consume an hour or more of physician time.

Possible solution: The addition of 96116 and the new explanatory text in CPT 2006--pointing physicians toward E/M codes for mini-mental status exams--might convince some payers that they should once again reimburse for full neurobehavioral status exams.

Learn more: For complete information on mental and mini-mental status exams, see -Here's How to Differentiate Mental Status Exams From Mini-MSE,- Neurology Coding Alert, May 2005.

Track 3 More Codes
 
Along with 96115, you-ll also need to scrub 96117 (Neuropsychological testing battery [e.g., Hastead Reitan, Luria WAIS-R] with interpretation and report, per hour) from your list of reportable services. CPT 2006 will delete the code and provide three new codes in its place:

- 96118--Neuropsychological testing (e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report

- 96119--Neuropsychological testing (e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face

- 96120--Neuropsychological testing (e.g., Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report.

Note: The descriptors for all of the new codes, with the exception of 96120, tell you that reporting is time-based per hour of physician time.

In designating these new codes, the AMA is trying to provide a better-detailed and more precise representation of physicians- services, Puente says.

Hurry up and wait: Until CMS reveals its 2006 Physician Fee Schedule and first quarter 2006 NCCI edits, you won't know how Medicare or other insurers will respond to 96116-96120.