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 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 ALL of the following criteria are met:
The test is used for the diagnosis, management and longitudinal care of individuals with neurologic disease
There is an initial evaluation and recommendation for neuropsychological testing made by ANY ONE of the following independent, (non financially associated) referral sources:
Attending physician,(i.e. MD, DO)
Nurse Practitioner, when consistent with state licensure
Neurologist
Neurosurgeon
The initial evaluation for individuals with symptoms undefined by an existing organic cause must include ALL of the following:
Objective screening test for cognitive dysfunction
Abnormal findings
Individuals who may benefit from neuropsychological testing include but are not limited to those with ANY ONE of the following:
Head injury
Learning disability
Degenerative diseases
Stroke
Epilepsy
Brain disorders (e.g., childhood, adolescence, adulthood, aging)
Difficult cases to diagnose
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Neuropsychological testing and assessment should not to be performed by any one of the following practitioners.
Licensed Clinical Social Worker (LCSW)
Licensed Senior Psychological Examiner (LSPE),
Licensed Marriage and Family Therapist (LMFT),
Licensed Psychological Examiner (LPE)
Licensed Professional Counselor (LPC)
Neuropsychological testing and assessment 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.
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
Ackerman-Banks Neuropsychological Rehabilitation Battery. (2007, July). Ackerman-Banks Neuropsychological Rehabilitation Battery (A-BNRB) fact sheet. Retrieved March 19, 2010 http://www.abackans.com/abnrb.html.
American Psychiatric Association. (2006, June). Practice guideline for the psychiatric evaluation of adults second edition. Retrieved March 19, 2010 from: http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=PsychEval2ePG_04-28-06.
Bonelli, S., Powell, R., Yogarajah, M., Samson, R., Symms, M., Thompson, P. et al. (2010). Imaging memory in temporal lobe epilepsy: predicting the effects of temporal lobe resection. Brain, 133 (Pt 4), 1186 - 1199. (Level 4 Evidence)
Complete Guide to Medicare Coverage Issues. [Computer software]. (2009, November). Psychological and neuropsychological tests (80.2, p. 4-212 - 4-215). The Ingenix Complete Guide to Medicare Coverage Issues.
Hayes. Medical Technology Directory. (2008, April). Cognitive rehabilitation for traumatic brain injury. Retrieved March 18, 2010 from www.Hayesinc.com/subscribers. (49 articles and/or guidelines reviewed)
Hayes. Medical Technology Directory. (2008, May). Neuropsychological testing for attention deficit/hyperactivity disorder (ADHD). Retrieved March 18, 2010 from www.Hayesinc.com/subscribers. (46 articles and/or guidelines reviewed)
Holtzer, R., Goldin, Y., Zimmerman, M., Katz, M., Buschke, H., & Lipton, R. (2008). Robust norms for selected neuropsychological tests in older adults. Archives of Clinical Neuropsychology, 23 (5), 531 - 541. (Level 4 Evidence)
National Academy of Neuropsychology. (2001). Definition of a Clinical Neuropsychologist. Retrieved March 19, 2010 from http://199.73.36.206/NAN/Files/PAIC/PDFs/NANPositionDefNeuro.pdf.
National Guideline Clearinghouse. National Center for Primary Care. (2006 June). Practice guidelines for the psychiatric evaluation of adults. Retrieved March 19, 2010 from: http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=9317&string=neuropsychological+AND+testing.
National Guideline Clearinghouse. National Center for Primary Care. (2008 January). The diagnosis and management of the epilepsies in adults and children in primary and secondary care. Retrieved March 19, 2010 from: http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=5963&string=neuropsychological+AND+testing.
National Guideline Clearinghouse. National Center for Primary Care. (2008 January). Practice parameter: screening and diagnosis of autism. Report of the quality standards subcommittee of the American Academy for Neurology and the Child Neurology Society. Retrieved March 19, 2010 from: http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=2822&string=neuropsychological+AND+testing.
Neuropsychology Central. Neuropsychological evaluation faq. Retrieved March 19, 2010 from http://www.neuropsychologycentral.com/interface/content/resources/resources_interface_frameset.html.
Pacific Neuropsychiatric Institute. (1997 - 2003) Neuropsychiatry: The interface area of psychiatry and neurology. Retrieved March 19, 2010 from: http://www.pni.org/neuropsychiatry/.
Puente, A., Adams, R., Barr, W., Bush, S., NAN Policy and Planning Committee, Ruff, R., et al. (2006). The use, education, training and supervision of neuropsychological test technicians (psychometrists) in clinical practice. Official statement of the National Academy of Neuropsychology. Archives of Clinical Neuropsychology, 21 (8), 837 - 839. (7 articles and/ or guidelines reviewed)
Tennessee Code: Title 63 Professions of the Healing Arts: Chapter 11 Psychologist: Part 2 General Provisions, Issue of licenses: TENN CODE ANN. § 63-11-203 (a, b).
U. S. Department of Health & Human Services. Centers for Medicare & Medicaid Services. LMRPs/LCDs for Wisconsin Physicians Service Insurance Corporation. (2008, September). LCD for Outpatient Psychiatry and psychology Services (L28318). Retrieved March 18, 2010 from: http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=28318&lcd_version=7&show=all.
U. S. Department of Health & Human Services. Centers for Medicare & Medicaid Services. Physician Self Referral . (2009, October).). Frequently asked questions. Retrieved March 18, 2010 from: https://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/print_alp.php?faq_array=9177,9179,9176.
ORIGINAL EFFECTIVE DATE: 10/1998
MOST RECENT REVIEW DATE: 5/13/2010
ID_BT
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