Medical Reimbursement Consultants since 1988, serving tens of thousands of physicians
There are 2 basic ways to perform a Cognitive Assessment:
1. Ask the patient questions and have them draw a clock. Contrary to what a pharma rep may have told you - this is NOT BILLABLE. You can call it a mini-mental-status exam - but it's not and when you get audited for billing an MMSE, you will be refunding large amounts of money plus penalties.
2. The other option is to have the patient complete a computerized neuro-psychological and a computerized psychological exam, which is payable. You get a complete report on the patient so you can see whether the patient has no cognitive problems, mild problems or perhaps needs a referral to a neuro psychologist.
Two CPT codes (96103 and 96120) are typically billed for the Cognitrax cognitive testing. Many docs are billing for what they think is the mini mental status exam, but when they get audited and pay money back to carriers, they realize they should not have listened to the pharmaceutical rep. Cognitive skills assessment is easy and can be performed by the nurse or M.A. IF done properly.
96103: Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI), administered by a computer, with qualified health care professional interpretation and report.
Average Medicare allowed: $ 28.39
96120: Neuropsychological testing (eg, Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report.
Average Medicare Allowed: $ 49.75
The average Medicare allowed is $78.14 and after the cost of $25 per patient, that gives the clinic a net increase of $53.14 per patient.
Our clients not only get a free - no risk - demonstration of the test, but they also get 5 free tests with their first order. The Cognitrax test costs $25 per patient. Instead of getting 10 for $250, our clients get an additional 5 at no extra charge.
This new code for 2018 replaced the G0506 code we had in 2017 and has an average Medicare allowed of $238.30.
Somes offices will benefit by using the CNS-VS test instead of the Cognitrax test (both are from CNS-VS). This code requires the physician or non physician practitioner (NP or PA) spend 30 minutes with the patient, which is why the reimbursement is so good.
Code 99483 has specific requirements (the ones with ** are elements that CNS VS helps assess and systematically documents):
● ** Cognition-focused evaluation including a pertinent history and exam.
● Use of standardized instruments to stage dementia.
● Medical decision making of moderate or high complexity. (defined by the E/M guidelines)
● ** Functional assessment including decision-making capacity.
● Medication reconciliation and review for high-risk medications, if applicable
● ** Evaluation for neuropsychiatric and behavioral symptoms , including depression, including use of standardized instrument(s).
● Identification of caregiver(s), caregiver knowledge, caregiver needs,
● ** Evaluation of safety , including motor vehicle operation, if applicable.
● Address palliative care needs, if applicable and consistent with beneficiary preference.
● Creation of a care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed; care plan shared with the patient and /or caregiver with initial education and support.
Do not report 99483 in conjunction with E/M services
CNS-VS Test Cost is $35 per patient, so net profit is slightly over $200
See a 2 page PDF handout you can give to your provider or biller explaining the components of the 99483 code
Q. My pharmaceutical rep said I can bill the MMSE (Mini Mental Status Exam) by having the patient complete a form with 12 questions. Is this true?
A. No! You have my permission to slap your pharmaceutical rep the next time they come in. Do not trust them to give you billing advice.
Q. Is there a setup charge when we go through you to get set up with CNS-VS or Cognitrax?
A. Nope. Your price is still the same whether you go through us or not - but with us, you get some free tests. Let us help you.