Neurosurgery Coding Alert

Mini-mental exams remain a component of E/M services

For neurosurgeons who have tried to gain reimbursement--and have been denied--for neurobehavioral status exams, CPT 2006 offers a new code and explanatory text that may convince payers to reconsider.

Say -Farewell- to 96115

As predicted, you-ll no longer have a reason to report 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).

As of January 2006, the American Medical Association will strike 96115 from CPT, says Antonio E. Puente, PhD, CPT advisory committee representative for the American Psychological Association. The AMA will replace 96115 with a new 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).

The rationale: -The AMA and the American Psychological Association believed that [a new code] would better represent the evolution of these services,- Puente says.

How 96116 Might Help

In the past, practices regularly (but incorrectly) reported 96115 for mini-mental status exams. Code 96115 properly describes an in-depth and lengthy evaluation of the patient's thinking, reasoning and judgment, says Anne M. Dunne, RN, MBA, MSCN, practice administrator for South Shore Neurologic Associates, PC/Brookhaven MRI, in Bay Shore, N.Y.

A mini-mental exam, in contrast, is a summary test that takes less than 15 minutes to perform and interpret.

Learn more: For complete information on mental and mini-mental status exams, see -Bundling's the Thing for Mental Status Exams,- Neurosurgery Coding Alert, April 2005.

In response to frequent errors and what they perceived as abusive billing, most payers will no longer reimburse for 96115--regardless of how well the physician documents the service. The National Correct Coding Initiative bundles 96115 to nearly all E/M codes, thereby disallowing separate payment. This creates an unfair situation for physicians who provide full mental status exams, because these services can consume an hour or more of his time.

However, the new code might convince some payers that they should once again reimburse for these services.

Hurry up and wait: Until CMS reveals its 2006 Physician Fee Schedule and first-quarter 2006 NCCI edits, we won't know how Medicare or other insurers will respond to 96116. Keep watching Neurosurgery Coding Alert for more information as it develops.