Neurology & Pain Management Coding Alert

Question: Which level of E/M service should I report when a patient visits our practice for migraine treatment?

Missouri Subscriber

Answer: CPT does not have an -automatic- E/M level for patients who report with migraines. Instead, the correct answer depends on the patient's condition when she arrives and the actions of your neurologist to diagnose and treat the migraine.

For example, if the patient has frequent migraines and reports to your practice for pain medicine or just an examination, you-d likely report either 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...) or 99213 for the visit. Base your code choice on medical necessity and your physician's documentation.
 
If the migraine treatment is more involved, you will probably be able to report a higher-level E/M code.

Example: If a patient who has never had a migraine before reports for treatment while the headache is in progress, your neurologist might perform a detailed history and exam, order lab tests and radiological studies and prescribe pain medicine. You might be able to report 99214 for this case, as long as the documentation supports medical decision-making of moderate complexity.

E/M services for migraines rarely warrant 99215, but it is possible. According to CPT, you must report 99215 for treatment of an -established patient having acute migraine with new onset neurological symptoms and whose headaches are unresponsive to previous attempts at management with a combination of preventive and abortive medication.-

New patient note: The same guidelines apply to new patients, which you would report with the appropriate choice from 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient ...).