Neurology & Pain Management Coding Alert

Critical care services have been redefined in CPT 2001. These codes (99291 and 99292) can be used only when the neurology patient is critically ill. According to the AMA, the further text revisions accepted for CPT 2001 were made to offer guidance to delineate when it is appropriate to report these codes as opposed to emergency services and other high-level E/M services.

These revisions will benefit neurology coders who previously had to fight with insurance companies to convince them that critical care services were provided and should be reimbursed. For example, problems often resulted because neurologists primarily deal with only one vital organ system, but payers felt that more than one system had to be in danger before critical care codes were appropriate. This has been cleared up in CPT 2001, which clearly states that one vital organ system can be in danger.

Critical Care Guidelines

Bryan Sorenson, senior administrator, University of Maryland Medical Center, department of neurology, reports that if the patient is neurologically unstable and the neurologist is working to stabilize his or her condition, it is appropriate to bill critical care codes.

He reminds neurologists that one of the key factors in gaining reimbursement is thorough documentation.

According to CPT 2001, documentation of critical care services should include the following:

Time spent in work directly related to the patients care whether at the bedside or on the floor or unit reviewing test results or imaging studies, discussing the patients care with medical staff, and documenting critical care services in the medical record.

When the patient is unable or clinically incompetent to participate in discussions, time spent on the floor or unit meeting with family members or surrogate decision makers obtaining a medical history, reviewing patients condition or prognosis, or discussing treatment or limitation(s) of treatment provided the conversation bears directly on the management of the patient.

Critical Care Code Changes for 2001

The introduction to the critical care codes in the CPT 2001 manual has been altered to include certain restrictions. The new language lists several elements that are key to understanding when billing for these services is appropriate. They include:

1. Critical Injury. CPT 2000 defined critical care as the delivery of care for a critically ill or injured patient. CPT 2001 inserts the word critically before injured, so there is no confusion about this: The patient must be critically injured.

2. Life Threatening. CPT 2000 provided that a critical illness or injury impairs one or more organ systems where the patients survival is jeopardized. CPT 2001 honed this language to state that the organ system impairment must include a high probability of imminent or life-threatening deterioration in his or [...]