Neurology & Pain Management Coding Alert

Question: Which codes should I use when the neurologist is called into a nursing home for a consultation with a stroke patient?

New York Subscriber Answer: You should choose the appropriate initial inpatient consultation code (99251-99255), depending on the level of service supported by the physician's documentation. The CPT definition of an initial inpatient consultation specifically states, "The following codes are used to report physician consultation provided to hospital inpatients, residents of nursing facilities, or patients in a partial hospital setting" [emphasis added].

For example, the resident physician at the nursing home requests that the neurologist evaluate a recent stroke patient who is slurring her speech and having motor problems. The neurologist conducts a 40-minute exam comprised of an expanded problem-focused history and examination and recommends further testing to evaluate potential neurological damage caused by the stroke. In this case, you should report 99252 (Initial inpatient consultation for a new or established patient ...).