Anesthesia Coding Alert

Coding and reimbursement for diabetes care is challenging, partly because the patient often has multiple diagnoses and treatments related to the diabetes that you must consider. One key factor in correctly coding these patients' pain-management treatments is familiarity with the many diabetes diagnosis codes. Start by Knowing Whether It's a Consult or Referral Almost half of diabetes patients have diabetic neuropathy, a nerve disorder caused by the disease. The patient loses sensation in the feet (and possibly the hands) and has foot pain and weakness. Numbness, pain or tingling in the hands, feet or legs is often the first sign of diabetic neuropathy. The condition can move slowly, taking years to lead to conditions such as foot muscle weakness. Occasionally, the condition suddenly flares up and affects a specific nerve, causing additional weakness or pain.
 
"The endocrinologist will manage the patient as long as he feels comfortable doing so," says Barbara Johnson, CPC, MPC, anesthesia coder with Loma Linda University Medical Anesthesiology Group in Loma Linda, Calif. "He might refer the patient to a pain management specialist for a consult and then follow the specialist's recommendations. If that fails, he would probably refer the patient to a pain specialist to care for that portion of her medical problems."
 
If the patient's initial visit to the pain physician qualifies for an office visit code, start by determining whether it was a consult or a visit/referral. A consult happens when the anesthesiologist sees a patient and recommends something related to treatment. A visit or referral, on the other hand, happens when another physician sends the patient to the anesthesiologist for treatment.
 
Code a new or established patient office consultation with the appropriate choice from 99241-99245 (Office consultation for a new or established patient); choose from 99251-99255 (Initial inpatient consultation for a new or established patient) for an inpatient consult. If the patient encounter is a visit/referral instead of a consult, choose from 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient). Know the Type of Pain  When you're coding for diabetic neuropathy treatment, you should understand the type of pain the patient is experiencing. Neuropathic pain can have up to three different components:
  ongoing pain that is continually present regardless of what the patient does or does not do
  spontaneous pain episodes that suddenly appear without any identifiable stimulus
  hyperalgesia, in which the patient has pain from an external stimulus that normally causes little or no pain (such as heat or cold).  In addition to being categorized by the type of pain experienced, the affected body area helps classify diabetic neuropathy. These include:
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