Get Paid for Higher Level Pediatric Neurology Exams
Published on Wed Mar 01, 2000
Before 1997, neurologists had to rely on general multisystem examination guidelines as prescribed by Medicare, which took several factors into account that were not specific to neurologists, including eyes, ears, nose, throat, cardiovascular, respiratory, and others. In 1997, the Health Care Financing Administration (HCFA) released the single-system examination guidelines for several specialties including neurology. But the initial design of the single system exam for neurologists did not take the child neurologist into consideration, according to Bruce H. Cohen, MD, chief of the Section of Pediatric Neurology and co-director of the Brain Tumor Center, which has more than 40 neurologists at the Cleveland Clinic Foundation in Cleveland, Ohio.
Examination details that add time to the standard pediatric neurological evaluation, such as neonatal reflexes and head circumference, were not included in the single system examination guidelines, Cohen explains. Yet performing and documenting the results of language repetition, a test that cannot be performed with an infant, is not only included, but also required.
Some third-party payers follow Medicare guidelines and maintain that if you cant do a memory and language test, you cant bill a level four initial examination (99204) or higher, Cohen says. These payers fail or refuse to recognize that only a small percentage of pediatric patients receive Medicare benefits for disabilities.
Substituting Items of Work
Richard A. Roski, MD, FACS, American Medical Association (AMA) CPT advisor for the American Association of Neurological Surgeons, says that the key to reimbursement may be in substituting items of work. While a pediatric neurologist will not be able to gain memory test results from an infant, there is the startle reflex check and other additional tests that can be clearly identified in the neurologists documentation, reports Roski, founder of Quad City Neurosurgical Associates, a medical practice specializing in the surgical treatment of the central nervous system. Adding these items of work to the examination documentation and submitting that documentation can help a neurologist to prove that he or she performed a comprehensive examination.
Addressing all the points raised in the single system examination is still important, even if it is to indicate that no results could be gained. When you do a neurological examination on a child, you have to comment, I tried to do cognitive testing, but it was not possible because of the patients age, Roski says. He adds, The evaluation and management (E/M) guidelines do not change for an adult or a child. The examinations history, review of systems and all other areas must be completed.
H. Terry Hutchison, MD, PhD, director of the Rehab Center for Pediatric Neurology at Valley Childrens Hospital Specialty Medical Group Inc., an integrated pediatric healthcare system in Madera, Calif., says that third-party [...]
