Neurology & Pain Management Coding Alert

Choosing the appropriate evaluation and management (E/M) service level is always challenging. Barbara Cobuzzi, MBA, CPC, CHBME, president of Cash Flow Solutions, a physician reimbursement consulting firm in Lakewood, N.J., that handles neurology reimbursement, says that a variety of coexisting conditions may accompany a patients presenting complaint. When co-existing conditions and the amount of time spent counseling the patient with or without her family present are not taken into account, a physician may charge for a lower E/M level than he or she should.

Checking for Coexisting Conditions

As physicians know, coexisting conditions may not be immediately apparent. The first indication the neurologist usually receives that coexisting conditions exist generally comes during the history-taking component of the initial patient visit (99201-99205). The information may come from the patient or the patients family.

Within the entire history component, there usually is a chief complaint, history of the present illness, review of body systems or areas, and a past/family/social history.

Catherine A. Brink, CMM, CPC, president of Healthcare Resource Management Inc., a practice management and reimbursement consulting firm in Spring Lake, N.J., that consults with several neurology practices, says that the neurologist may uncover a variety of coexisting conditions, such as malignant hypertension (401.0), insulin dependent diabetes (250.01), congestive heart failure (428.0), or respiratory cardiovascular problems during the review of systems portion of the history-taking. The complexity and number of coexisting conditions the neurologist uncovers during the history may dictate how detailed an examination he or she will need to perform, she reports.

The neurologist may choose the appropriate E/M level to bill for the visit in one of two ways. The neurologist may review the documented history that was taken from the patient and family, the exam that was performed on the patient, and the medical decision-making that was needed for this patient and make the choice depending on the severity of the patients complaint and the complexity of the aforementioned three key factors: history taking, examination and level of medical decision-making. The neurologist also may choose to code by time when more than 50 percent of the total visit was spent on counseling and coordination of care for the patient.

Coding for Time

For example, a 70-year-old patient presents with symptoms of memory loss (780.9). If the neurologist met with the patient for 45 minutes, the visit could be coded as a 99204 (office or other outpatient visit for the evaluation and management of a new patient that requires a comprehensive history and examination and medical decision- making of moderate complexity) rather than a 99203 (office or other outpatient visit for the evaluation and management of a new patient that requires a detailed history and examination and [...]