Neurology & Pain Management Coding Alert

Question: When an emergency department (ED) physician calls and says he has a patient who needs a neurological consult, and the ED physician sends the patient to the neurologist on call in the neurological office, is this as a consult or a new patient visit?

South Carolina Subscriber

Answer: The complication with consults versus visits is that you have to know the intent of the referring physician. If the referring physicians intent is to transfer care to your neurologist, then it is a visit (that is, a new or established patient). If the referring physicians intent is to ask your neurologists opinion but continue care of the patients condition himself, then it is a consult.

In this scenario, the patient was sent to your neurologists office and the ED physician is not asking for your neurologists opinion or advice on the patients condition;

rather he is transferring care of the patients condition to your neurologist. Therefore, the E/M service category would be either new patient or established patient, depending on if the patient has been seen by your neurologist or a neurologist in your group in the past three years.

Tip: In contrast, if your neurologist is asked to see the patient in the ED and provide his opinion on the patients  diagnosis and/or advice on treatment options, this more likely meets the Request component of the 3 Rs of a consultation service -- Request, Render, and Report back.