K042 – Extended specific neurocognitive assessment
OHIP Consultation & Visit Premium Codes Code — CONSULTATIONS AND VISITS · Schedule of Benefits
An extended specific neurocognitive assessment is an assessment of neurocognitive function rendered personally by the physician where all of the following requirements are met: - test of memory, attention, language, visuospatial function and executive function; - a minimum of 46 minutes (consecutive or non-consecutive) must be dedicated exclusively to this service (including administration of the tests and scoring) and must be completed on the same day; and - the start and stop time(s) must be recorded in the patient's medical record.
When to Use
- Use K042 when performing a comprehensive battery such as the TorCA or a combination like BNA-SF plus MoCA that requires at least 46 minutes of dedicated physician time.
- Select K042 over K032 when the clinical complexity necessitates a more extensive neurocognitive evaluation than a standard assessment, provided the 46-minute threshold is met.
Common Pitfalls
- Billing K042 for a single test like the MoCA or MMSE alone will result in a rejection, as these do not constitute an 'extended' battery.
- Failing to document the specific start and stop times in the chart is a primary cause for audit recovery, even if the clinical work was performed.
- Attempting to bill K042 and K032 on the same day for the same patient is prohibited and will trigger an automatic rejection.
Billing Tips
- Ensure your documentation explicitly lists the specific tests administered to prove the battery covers memory, attention, language, visuospatial, and executive function domains.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Assessments
The start and stop time(s) must be recorded in the patient's medical record.
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