Neurology & Pain Management Coding Alert

CMS guidelines prohibit separate billing

When you code a mini-mental status exam (MMSE), don't make the common mistake of claiming 96115. Rather, you should include an MMSE in any E/M service the neurologist also provides.

Look to Physician Notes to Distinguish MMSE

If the neurologist's documentation describes a cursory mental exam lasting 20 or fewer minutes, you cannot charge separately for the service, says Anne M. Dunne, RN, MBA, MSCN, administrator for South Shore Neurologic Associates PC in Long Island, N.Y.

Another way: If, on the other hand, the neurologist documents an extensive clinical evaluation of the patient's cognitive function (of the central nervous system) lasting one hour or more, you may be able to support coding for 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), depending on the payer.

Warning: In most cases, a neurologist would not report a mental status exam (96115) because the service would be outside his normal scope-of-practice. And some Medicare Part B carriers restrict 96115 to psychiatrists, independently practicing psychologists, and clinical psychologists.

Fold MMSE Into E/M
 
Although CPT does not contain a separate code for MMSE, you can often account for the neurologist's testing in any E/M services the neurologist also provides.

If the MMSE contributes significantly to the elements of exam, history and medical decision-making, you may report a higher-level E/M service. In particular, an MMSE may raise the "exam" portion of the E/M service.

Example: The neurologist provides a consult for a new patient with memory loss, dizziness and other symptoms, which includes a comprehensive history, a detailed exam and high-complexity medical decision-making.

As a final step to assess the patient, the neurologist conducts an MMSE, which raises the level of this particular examination to comprehensive.
 
In this case, you can report 99205 (Office or other outpatient visit for the evaluation and management of a new patient ...), rather than the lower-level service 99204.
 
Alternative: If counseling and coordination of care consume more than 50 percent of the visit, you may use time as the determining factor when assigning an E/M level, says Barbara J Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc., in Brick, N.J.
 
For instance, the neurologist spends 20 minutes taking the patient's history and performing a physical exam, and 15 minutes doing an MMSE. He then speaks with the patient about his condition for an additional 45 minutes.

In this case, the MMSE will make the difference between 99244 and 99245 (Office consultation ...).

When reporting time-based E/M services, document carefully the time spent face-to-face in counseling or coordinating care with the patient or family.