Neurology & Pain Management Coding Alert

Question: I am having a difficult time obtaining reimbursement for the Mini Mental Status Exam my neurologist is performing, even after sending all the required documentation. I am billing 96116 for this exam. What are the guidelines for this?

California Subscriber

Answer: 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) is not the appropriate code for the Mini Mental Status Exam (MMSE). According to CPT 2008, the MMSE is part of an E/M service. You should use 96116 to report more comprehensive testing of the cognitive function of the central nervous system.

Code 96116 is a psychological testing code describing a specific test administered to determine neurobehavioral status. The neurobehavioral testing tool described in 96116 is longer and more detailed than the MMSE, and usually takes an hour to complete in addition to any E/M services provided.

Use E/M: Keep careful documentation on your neurologist's total visit time, the time spent counseling and/or coordinating care, and sufficient detail as to the extent of the counseling when you select the E/M code.

Take note: In most cases, performance and documentation of the MMSE during a patient E/M visit will not support reporting a prolonged service add-on code.