Neuropsychological Testing and Assessment When Performed by a Clinical Neuropsychologist
DESCRIPTION
Neuropsychological testing and assessment is done to verify the presence or absence of brain dysfunction in individuals by measuring various components of cognitive function. These cognitive functions include attention, executive functions, sensation and perception, motor performance memory, language, and intelligence. Quantitative methods, originating from the fields of psychology and behavioral neurology, are used in the clinical neuropsychological examination to evaluate cognitive abilities in individuals with known or suspected brain dysfunction. A Clinical Neuropsychologist is a professional psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system.
Cognitive disorders can result from systemic, viral or bacterial infections that affect the central nervous system. Human immunodeficiency virus (HIV), herpes, toxoplasmosis, and Lyme Borrelia are among the most common pathogens that are associated with subsequent neurologic dysfunction. Cognitive disorders can also occur from inborn errors of metabolism. Phenylketonuria, maternal phenylketonuria, maple syrup urine disease, homocystinuria, methylmalonic acidemia, propionic acidemia, isovaleric acidemia and other disorders of leucine metabolism, glutaric acidemia type I and tyrosinemia types I and II, and urea cycle disorders are rare inborn errors of metabolism that if untreated can result in severe mental retardation or death. Testing for cognitive deficits due to infectious disease or inborn errors of metabolize may involve a standard battery of tests or utilize tests that are individualized to the specific reported problem.
Dementia and its underlying etiology can be identified through neuropsychological testing and assessment utilizing tests of global measures of function or a measure of cognitive function along with a test of behavioral or emotional symptoms. For brain injured individuals, neuropsychological testing and assessment can provide supportive evidence for localizing lesions. It is necessary to diagnose functional deficits, to formulate a rehabilitation and treatment plan of care, and to provide a rational view of the individual's future. Another advantage of the testing and assessment is its ability to identify cognitive deficits that result from diffuse but significant damage to the brain that can be missed by imaging techniques.
POLICY
Neuropsychological testing and assessment by a Clinical Neuropsychologist for the diagnosis, management and longitudinal care of individuals with neurologic disease is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
MEDICAL APPROPRIATENESS
Neuropsychological testing and assessment by a Clinical Neuropsychologist is considered medically appropriate if the following criteria are met:
There is an initial evaluation and recommendation for neuropsychological testing by a neurologist or neurosurgeon.
If an existing organic basis for symptoms has not been documented, then the evaluation prior to neuropsychological testing must include an objective screening test for cognitive dysfunction with abnormal findings.
Individuals who may benefit from neuropsychological testing are those with a head injury, a learning disability, degenerative diseases, a stroke, epilepsy, and brain disorders of childhood, adolescence, adulthood, and aging.
Neuropsychological testing may be utilized for difficult to diagnose cases where a psychiatric disorder (e.g., schizophrenia, depression) is also present. In these cases, it is used to diagnose or rule out concomitant organic disorder. Neuropsychological testing in these circumstances would be considered a medical service, not a behavioral health (BHO) service.
ADDITIONAL INFORMATION
This policy is only applicable to Clinical Neuropsychologists and does not apply to any other professional group.
Neuropsychological testing is a method of assessing functional abilities associated with developmental, degenerative, and acquired brain disorders. It is used to assess cognitive, perceptual and motor capacities and processes that range from simple motor performance to complex problem solving and reasoning. Test results reflect functional capacity and are not diagnostic of specific etiology or precise localization of neurological disease. Test results are compared to norms derived from non-brain injured individuals and are therefore not appropriate as part of a general mental health evaluation.
SOURCES
A Neuropsychology Homepage. What is a neuropsychologist? Retrieved June 19, 2001 from http://www.tbidoc.com/Appel2.html.
Ackerman-Banks Neuropsychological Rehabilitation Battery. Ackerman-Banks Neuropsychological Rehabilitation Battery (A-BNRB) fact sheet. Retrieved June 19, 2001 http://www.abackans.com/abnrb.html.
Agency for Healthcare Research and Quality. (1996, September). Early Alzheimer's disease: Recognition and Assessment. Guideline Overview No. 19. Retrieved June 22, 2001 from http://www.ahcpr.gov/clinic/alzover.htm.
Complete Guide to Medicare Coverage Issues. [Computer software]. (2007, November). Psychological and neuropsychological tests (80.2, p. 4-202 - 4-203). St. Anthony Publishing.
Hayes Medical Technology Directory. (1997, July). Neuropsychological assessment for traumatic brain injury (NEUR0403.04). Retrieved May 23, 2003 from Hayes Inc Online.
Moore, P. M., & Baker, G. A. (2002). The neuropsychological and emotional consequences of living with intractable temporal lobe epilepsy: implications for clinical management. Seizure, 11(4), 224-30. Abstract retrieved May 27, 2003 from PubMed database.
National Academy of Neuropsychology. (2001). Definition of a Clinical Neuropsychologist. Retrieved February 13, 2008 from https://www.nanonline.org/PostitionPageLinks/Pages/DefinitionofaNeuropsychologist.aspx.
National Institutes of Health. (1987, July). NIH consensus statement. Differential diagnosis of dementing diseases. Retrieved June 22, 2001 Retrieved February 13, 2008 from http://consensus.nih.gov/1987/1987DementiaDiagnosis063html.htm.
Neuropsychology Central. Neuropsychological evaluation faq. Retrieved February 13, 2008 from http://www.neuropsychologycentral.com/interface/content/resources/resources_interface_frameset.html.
Pacific Neuropsychiatric Institute. Neuropsychiatry: The interface area of psychiatry and neurology. Retrieved June 19, 2001 from http://www.pni.org/neuropsychiatry/.
Solomon, P. R., Hirschoff, A., Kelly, B., Relin, M., Brush, M., De Veaux, R. D., et al. (1998). A 7 minute neurocognitive screening battery highly sensitive to Alzheimer's disease. Archives of Neurology, 55 (3), 349-55.
University of Iowa Health Care. (2001). Neuropsychology test. Retrieved June 22, 2001 from http://www.vh.org/Patients/IHB/Neuro/Neuropsychology/Neuropsychology.html.
University of Iowa News Service. (2004). UI expert explains usefulness of memory, other cognitive tests. Retrieved February 13, 2008 from http://itsnt166.iowa.uiowa.edu/uns-archives/2004/march/030404memory-tests.html.
ORIGINAL EFFECTIVE DATE: 10/1998
MOST RECENT REVIEW DATE: 3/27/2008
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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