Neurosurgery Coding Alert

Question: Does Medicare reimburse for mini-mental exams? If the service is part of an E/M, how much weight should it be given when determining the level of service?

Maine Subscriber

 
Answer: Mini-mental state exams (MMSEs) are not separately reimbursable by Medicare and are integral to any E/M service reported.
 
Although it should be considered when selecting an E/M code, an MMSE does not automatically raise the level of service. E/M levels must be chosen according to the three components of exam, history and medical decision-making. Only if the MMSE contributes significantly to these components can a higher-level E/M service be reported. Specifically, the MMSE may contribute to the neurological and psychiatric exam portion of the service.
 
If counseling and coordination of care consume more than 50 percent of the visit, time can be used as the determining factor for most E/M services. For instance, if after undergoing an MMSE an established patient discusses his or her condition with the physician (or the physician discusses the patients condition with the patients family) for 30 minutes of a 55-minute visit, the visit may be coded 99215 (office or other outpatient visit for the evaluation and management of an established patient ) based on time alone. Be sure to maintain careful documentation outlining the time spent face-to-face, counseling or coordinating care.
 
Do not 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) for an MMSE. Most insurers will only reimburse this code for a mental-health professional. Although some carriers may pay, this is improper coding and could result in extrapolated payment recoupment and other penalties if discovered during an audit.