Neurology & Pain Management Coding Alert

Question: One of our physicians conducted a consult on a brain-dead patient at the request of the transplant organization (the patient is an organ donor). The family requested a second opinion, so another physician from the same group provided a consult later that day. Each physician spent approximately an hour with the patient. How should I code their services?

Indiana Subscriber

Answer: Coders and physicians have various opinions on how to report these cases, so talk with your physician and the carrier to be sure you fully understand the services before filing.

Physician 1: Some experts advise reporting critical care codes for your first physician. If you believe this route is best, submit 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (- each additional 30 minutes [list separately in addition to code for primary service]) as appropriate for your first physician, based on the amount of time he spent with the patient.

Other experts say to report the first physician's service with the appropriate choice from 99251-99255 (Inpatient consultation for a new or established patient -) instead, based on the amount of time your physician spent on the consult.

Physician 2: Coders also have different answers for the second physician's service. You can also report a consultation code for the second physician (99251-99255). Some physicians, however, are more comfortable with 99499 (Unlisted evaluation and management service) than a consultation code, so verify which your neurologist believes applies.

Final note: The patient's carrier might not pay for either service, but you should still submit them for accuracy's sake.