Neurology & Pain Management Coding Alert

Question: If your physician is on-call for another group and he sees a patient for the first time, is a new or established patient visit billed?

Arizona Subscriber

Answer: If the neurologist has not seen the patient before, he may have to perform a more extensive exam. For that reason, many coders believe that on-call services warrant use of billing initial hospital care (99221-99223) or initial inpatient consultation (99251-99255) codes. However, CPT 2001 states, in the instance where a physician is on-call for or covering for another, the patients encounter will be classified as it would have been by the doctor who is not available. Therefore, if the physician is checking on a patient who was admitted by another doctor, you would bill the subsequent hospital care codes (99231-99233).

The on-call neurologist can only bill for an initial inpatient consultation if the patient was referred directly to him or the physician hes covering for, or if he were the admitting doctor. In addition, the visit would have to meet all the criteria of a consult (request for consultation, review of the patient, and report back to the referring physician).

The only exception to the on-call billing rule occurs when the on-call neurologist is visiting a patient during the postsurgical global period (generally 90 days). In that case, no billing should occur. To get paid for such on-call services, you can work out an arrangement with the practice, or trade services on a quid-pro-quo basis, which works well for many practices.