Neurology & Pain Management Coding Alert

Question: One of our established Medicare patients is a resident at an assisted living facility. She has uncontrolled type II diabetes. How should we report E/M services the neurologist provides the patient at the facility? The only CPT codes I can find are 99339 and 99340, but these codes don't seem to match up to the service the physician provided.

Minnesota Subscriber

Answer: You should not use 99339 (Individual physician supervision of a patient [patient not present] in home, domiciliary or rest home [e.g., assisted living facility] requiring complex and multidisciplinary care modalities -; 15-29 minutes) or 99340 (- 30 minutes or more) for E/Ms conducted at an assisted living facility. These codes are for care plan oversight of home care, not E/M services in assisted living facilities.

Instead, you should choose from 99334-99337 for face-to-face E/M services the physician provides to established assisted living patients, depending on the service level.

Example: Your physician travels to the assisted living facility and performs a detailed interval history, a detailed examination, and medical decision-making (MDM) of moderate complexity. In this scenario, you would report:

Exception: If the physician is seeing a new patient and providing an E/M service at an assisted living facility, choose from the 99324-99328 code set. Suppose the patient in the above example was a new patient. Instead of reporting 99336 for detailed history/examination and moderate MDM, you would submit:

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CodeRyte Inc. coding analyst and coding review teacher.