Neurology & Pain Management Coding Alert

Pre-operative consultations (99241-99245) can be a big contributor to a neurology practices revenue, but they also can be a target for auditors. Here are some simple rules to follow to ensure that your pre-op consults are fully reimbursed, without challenges.

Physician visits to a patient the day before or the day of surgery often will be rejected for reimbursement if theyre billed as consults. Most carriers consider these visits part of the global period.

Physicians often do not grasp the definition of a global surgery period, says Anne Cunningham, RN, MBA, compliance manager at Boston Medical Center. It is the normal pre-operative service given before surgery, the actual procedure, and normal follow-up care.

Yet, a neurologist certainly has the right to bill a pre-op consult if that consult yields a decision for surgery, says Cunningham. For example, a patient is in the hospital for a service other than neurology, and the attending physician calls the neurologist, saying the patient has back pain and requests that the neurologist come in and take a look. If that consultation results in a decision for surgery, then it can be billed as a pre-op consult by the neurologist.

The key, says Cunningham, is to apply modifier -57
(decision for surgery) if the consult falls within the global surgery period. That period normally extends only to the day before surgery, but some carriers have a three-day window. If the neurologist fails to apply modifier 57, reimbursement may be denied, Cunningham says. And in some cases, a carrier may require a confirmatory consult code (99271-99275) before surgery.

Document Diligently to Protect
Your Pre-op Referral

Neurologists sometimes forget that they need to have the request for a pre-op consult documented, says Cunningham. She recommends that the consulting neurologist always ask for a written request and follow that up with a letter that confirms the consult. I usually recommend a letter that says, Thank you for sending me this consultation. That ensures that the patients consultation visit isnt confused with a new patient visit.

Cunningham also advises practices to develop consult forms. The requesting physician fills out the form, checking off boxes that clearly state whether the patient is being sent for an opinion or treatment. I always go back to this: what are you being asked to do? Render an opinion or care for the patient? [Editors Note: Assumption of care is not a consult.] The choice is really the responsibility of the requesting physician, but the liability for the misunderstanding or mixup is with the consulting physician.

A form allows the requesting physician to give instructions while providing the documentation that protects the consulting physician, says Cunningham.