Neurology & Pain Management Coding Alert

Question: What guidelines apply to reporting 96116 with other tests?

Oregon Subscriber

Answer: CMS has specific guidelines regarding what you can -- or cannot -- report with 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). Some of these guidelines include:

- Do not report 96116 when your neurologist performs a mini-mental status examination; the E/M service includes the mini-mental status exam. 

- Do not report 96116 with psychiatric diagnostic exams 90801 (Psychiatric diagnostic interview examination) or 90802 (Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication).

- Report 96116 with other psychiatric services or E/M services only if your physician also administers a complete neurobehavioral status exam.