Neurology & Pain Management Coding Alert

Question: A parent has an appointment to show our neurologist reports on tests conducted on her child who is a minor. The parent wants the doctor's advice on how to proceed and needs a signature to complete further testing. Should this be coded as a consultation?
      
Texas Subscriber

 
Answer: Yes, it is appropriate to assign a confirmatory consultation code (99271-99275). These codes may be used for adults seeking a confirmatory consultation for themselves or, in the case of a minor, may be conducted with the parent or legal guardian on behalf of the patient. Similarly, they may be used in situations where adults are suffering from debilitating conditions that prevent them from making their own medical decisions and where others have been legally assigned this responsibility.
 
When you use 99271-99275, the minor patient does not necessarily need to be present. If this is the case, the neurologist should clearly document that the consultative services centered on the patient. Even though the patient might be present for the discussion, the primary reason for the visit is counseling, therefore, the history, exam and medical decision-making components of the code might not be met. You should note that the neurologist should rely on time, rather than the key elements, if the counseling comprises 50 percent or more of the visit.
 
Be advised, however, that you may have difficulty receiving payment for a confirmatory consultation under the circumstances described in your question. It is usually paid if the insurance company requests it, not the patient, parents or legal guardians. It is advisable to check with your carrier for their policy. If they do not, you should inform the patient (or, in this case, the patient's family) and let them know that they will be responsible for payment before the consultation is performed.