Billing, Coding and Compliance

Introduction and Quick Guide

Although medical billing has not gotten easier in recent years, Mentegram enabled procedures submitted by psychiatrists and psychologists have been successfully reimbursed by healthcare insurance companies. This section presents the information we have gathered to help you chart and code Mentegram results. Billing practices vary widely from region to region, and even across third payers. While there is no substitute for a consultation with a competent coding expert, here are some guidelines that you might find useful.

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Mentegram as a tool for psychological and neuropsychological testing

Mentegram procedures are coded using specific CPT procedure codes. These codes are widely used nationwide and their inclusion in health benefit plans is mandated by Center for Medicare and Medicaid Services (CMS). Specific guidelines for reimbursement do vary, however, so please seek guidance from your payer(s). In general, these procedures must be performed under the supervision of licensed provider, or based on an order from a physician (psychiatrist) or clinical psychologist.

Screening

CPT code 96110: “Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument” may be used to report screening assessments (e.g., speech, language, growth). Depending on local or national carrier policies code 96110 may be applicable for reporting screening procedures using Mentegram. Specific coding requirements may also apply, such as the use of appropriate modifiers. CPT Code 96127: “Brief emotional/behavioral assessment (for example, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument” may be used to report a brief assessment for suspected emotional and/or behavioral problem (e.g., ADHD, depression, suicidal risk, anxiety, substance abuse, eating disorders). This code is new in 2015 and came about in response to the federal mandate to include mental health services as one of the benefits that must be offered by all insurance plans covered by Affordable Care Act. This includes depression screening for adults and adolescents, alcohol and drug misuse in adults and adolescents, and behavioral assessments in children and adolescents.

Relevant CPT Codes

96110- Developmental screen with scoring and documentation, per standardized instrument
96127- Brief emotional/behavioral assessment with scoring and documentation, per standardized instrument. New for 2015

Assessment

Code 96103 may be applicable, depending upon payer policies, for reimbursement for the administration of assessments through Mentegram. This code requires that each administration of an assessment is medically necessary and the report justifies the necessity of each billed assessment. Code 96101 reimburses for the clinician's (physician or clinical psychologist) time administering, interpreting assessments, and for the additional time needed to integrate assessment results with other information about the patient. Some insurance providers expect additional clinician’s time billed in conjunction with the assessment (for writing up the report); others expect that the clinician’s time for interpretation of the assessment is accounted for in the 96103 code – please check with your insurance provider for specific guidelines. Sometimes the appropriate procedure code depends on the ultimate diagnosis. If assessments were performed to diagnose for neurological impairments, such as aphasia, coding for neurological and neuropsychological is more appropriate. Codes 96120 and 96116 roughly correspond to 96103 and 96101, respectively, when used in the context of a neurological impairment. Please note that some providers informed us that they expect only one neurological assessment per incident of an illness, and no more than one assessment every three months. Please seek guidance from your provider.Relevant CPT Codes

96103 - Testing & Interpretation Psychological testing administered by a computer with qualified health care professional interpretation and report.
96101 - Integration of Additional information by Physician per hour of the qualified healthcare professional time.
96120 - Testing & Interpretation Neuropsychological testing, administered by a computer, with qualified health care professional interpretation and report.
96118 - Integration of Additional information by Physician per hour of the qualified healthcare professional time.