Neurology & Pain Management Coding Alert

Question: My physician shares coverage with another neurologist. When he is on call and sees one of the other doctors patients to write a hospital follow-up note, can I bill for a new patient evaluation if it is the first time he has examined the patient?

South Carolina Subscriber

Answer: Your answer depends on whether the neurologist had access to the patients medical record. If he or she did, it is considered an established patient visit (99211-99215). If he is covering for another neurologist, he should have access to those records. If, on the other hand, the neurologist sent a patient to him and he was not a member of the same practice, he did not have access to the medical records and you could bill it as a new patient visit (99201-99205).

Another option is that the original neurologist bills for the visit with HCPCS modifier -Q5 (service furnished by a substitute physician under a reciprocal billing arrangement) to indicate reciprocal coverage. If the covering physician admits or does a consult on the patient of another doctor, the admit or consult is billed up until the time the care is transferred to the original neurologist.