Neurology & Pain Management Coding Alert

Question: Our neurologist is one of several doctors managing a diabetic patient in the hospital. When we report an inpatient visit for this patient, the payer denies the claim. What are we doing wrong?

Michigan Subscriber

Answer: Billing for concurrent care can be a challenge, because there are no concurrent care modifiers or CPT codes - you must use the standard E/M and procedure codes. Therefore, the only way to tell the payer that you're providing services separately from another specialist is to use a different primary diagnosis (that is, only a unique diagnosis can prove that the physician is not providing redundant care).
 
When providing concurrent care, code for the reason the physician sees the patient, rather than for the reason the patient is in the hospital. The only exception to this is if the reason the patient is in the hospital relates directly to the condition the physician is treating.
 
For example, a neurologist providing concurrent care to a diabetic patient (as an inpatient or outpatient) should assign an ICD-9 code for the specific disorder he is treating, such as diabetic neuropathy (357.2, Poly-neuropathy in diabetes; in this instance you would also list the underlying disease, 250.6x, Diabetes with neurological manifestations). A simple diagnosis of diabetes (250.xx) without additional information will leave the payer wondering why the neurologist's services are necessary.