Neurology & Pain Management Coding Alert

Question: One of our neurologists performs a mental assessment on patients if he suspects they have had a stroke, have early signs of dementia, or are feeling confused. He is using a written mini-mental check or status test, which is a set of questions with a calculated score. Can we use 90802 in addition to the appropriate level of E/M service for this test? Is another code more appropriate?

California Subscriber

Answer: Code 90802 (interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication) would not be appropriate for a mini-mental status examination. It should be used for a complete psychiatric interview for children or adults who cannot communicate. It is usually an hour-long exam and is not considered a mini-mental.

According to the local coverage policy for Cahaba Government Benefits Administrators Inc., the Medicare carrier for Georgia, 90802 is paid only when the patient is younger than 16 years of age, or when an adult is in-capable of verbal communication.

Procedure 90802 is used mainly by child psychiatrists, psychologists and clinical social workers when they initially evaluate children who do not have the ability to interact with ordinary verbal communication the policy states. It may also be applied to the initial evaluation of adult patients with organic mental deficits, or who are catatonic or mute.

The Interactive Medical Psychiatric Diagnostic Interview Examination (90802) includes the same components as the Psychiatric Diagnosis Interview Examination, (90801) which includes history, mental status, disposition and other components as indicated. However, in the interactive examination, the physician uses inanimate objects, such as toys and dolls for a child, physical aids and non-verbal communications to overcome barriers to therapeutic interaction, or an interpreter for a deaf person or one who does not speak English.

Code 90802 is covered for the interactive evaluations of children who are 16 years of age or younger, and of adults, who have one of the following conditions:

295.20-295.25 schizophrenic disorders; catatonic type;

299.00 psychoses with origin specific to childhood; infantile autism, current or active state; and

299.80 psychoses with origin specific to childhood; other specified early childhood psychoses, borderline psychosis of childhood.

According to the 1997 E/M Documentation Guidelines, the mini-mental status examination is a tool to help neurologists perform a comprehensive examination.

Therefore, this service is included in the overall E/M code.

Regarding the written examination form you mentioned, a number of pharmaceutical sales representatives are giving these to neurologists and telling them that a mini-mental status examination is a separately payable service when the forms are filled out and scored. This is untrue. A close look at the form reveals that its questions help the neurologist to ensure that the patient is oriented to date, time and place and checks basic recall and calculation skills. This is almost verbatim the bullet items from the comprehensive neurological workup from the 1997 HCFA examination guidelines.

The most common code that is reported for mini-mental status examinations is 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), but it is not correct. Code 96115 should be used when the neurologist performs special testing, not a brief check. A clue in the codes definition states that it should be reported per hour. A mini-mental check usually takes about 10 to 20 minutes. The mini-mental-status is a neurological exam, which includes a psychiatric component, but not any special testing. Codes 96100-96117 (central nervous system assessments/tests [e.g., neuro-cognitive, mental status, speech testing]) represent special testing when the neurologist has determined that a problem must be addressed further. These codes are billed per hour because the exam usually takes several hours.