Neurology & Pain Management Coding Alert

Question: Our neurologist spent 40 minutes evaluating a stroke patient prior to admission. He then spent an additional hour with the patient monitoring him during the CT scan and t-PA administration. How should we report this?

New York Subscriber

Answer: In this case, the 40 minutes spent evaluating the patient count toward the hospital admission (99223, Initial hospital care ... with a comprehensive history, comprehensive examination, and medical decision-making of high complexity, if the physician has appropriate documentation). You cannot count this time again toward the prolonged services total.
 
For the prolonged services, report +99356 (Prolonged physician service in the inpatient setting, requiring direct [face-to-face] patient contact beyond the usual service [e.g., maternal fetal monitoring for high-risk delivery or other physiological monitoring, prolonged care of an acutely ill inpatient]; first hour [list separately in addition to code for inpatient evaluation and management service]) for one hour of prolonged services in addition to the admission.
  
Only the admitting physician may use the initial care codes per patient per hospital stay. If the neurologist tends to the patient following admission and E/M by another physician, the neurologist must report the subsequent hospital care codes (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...) unless the service meets the specific requirements for a consult.