Neurology & Pain Management Coding Alert

Question: I would like to start using the MMPI (Minnesota Multiphasic Personality Inventory), CPT code 96100, for my migraine patients. Will Medicare deny benefits because I am a neurologist?

Armen Cherik, MD
New York, N.Y.

Answer: The MMPI is a personality test that consists of 550 affirmative statements to which the patient can respond True, False or Cannot Say. It has a wide range of content including statements regarding health, neurological disorders, motor disturbances, social attitudes, issues relating to family, education, occupation and marriage, as well as questions relating to neurotic or psychotic behavioral manifestations, hallucinations, phobias and other trends. The original MMPI provides scores on 10 clinical scales and three validity scales that can be used to determine how much the patient is lying during the test to ensure the validity of the results.

Mental-health providers reimbursed under Part B for their services include psychiatrists, clinical psychologists (who meet specified requirements), non-clinical psychologists and clinical social workers (who meet certain criteria). A neurologist will need to contact the Medicare representatives in his or her state to determine if performing diagnostic psychological tests such as those falling under code 96100 (psychological testing [includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI] with interpretation and report, per hour) will be reimbursed.

The specific diagnosis codes that are accepted by Medicare for billing 96100 can be provided by local Medicare carriers. If a clinical social worker is on staff, that person may be covered by Medicare. In this case, the neurologist should check with his or her Medicaid carrier for a ruling on coverage of 96100 as performed by a clinical social worker under a neurologists supervision.

Source for Reader Questions: Catherine Brink, CMM, CPC, president of Healthcare Resources Management Inc., a practice management and reimbursement consulting firm in Spring Lake, N.J., that consults with several neurology practices.