Eli's Rehab Report

Question: One of our physiatrists performed a mental assessment on a patient who exhibited symptoms of a stroke. He used a written "mini-mental" status list, which included 25 questions with weighted scores. Can we report 90802 (Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication) for these tests, plus the appropriate E/M code?

Georgia Subscriber

Answer: You should not report 90802 for a mini-mental status examination (MMSE). Code 90802 is reserved for actual psychiatric interviews when children or adults cannot communicate with the providers. The local coverage policy for Cahaba Government Benefits Administrators Inc., Georgia's Medicare carrier, states, "Procedure 90802 is used mainly by child psychiatrists, psychologists and clinical social workers when they initially evaluate children who do not have the ability to interact with ordinary verbal communication."

The October 2000 CPT Assistant refers to the MMSE as "a 30-element examination, originally created to provide a very quick and simple summary test, which could be standardized and used with minimal time required. In general, the MMSE takes less than 15 minutes to perform and interpret. It was never meant to substitute for more comprehensive testing."

Physicians administer the exam which can be a valuable diagnostic tool for stroke victims to test a patient's mental acumen and awareness. If your documentation describes only a cursory exam of 30 minutes or less, Medicare considers the testing part of any associated consultation, clinical interview or E/M service and will not pay it as a separate, reimbursable service.

Although you may consider the MMSE when selecting an E/M code, it does not automatically raise the E/M service level. You must select E/M levels based on the three components of exam, history and medical decision-making. Most practices consider MMSEs part of the physical exam.