Neurology & Pain Management Coding Alert

Question: Our practice hired a new neurologist after another neurologist retired. The patients are not new to the practice. How should I code patient follow-ups to the new neurologist?

Colorado Subscriber

Answer: CPT rules state that patients are considered "established" if they have had a face-to-face professional service with the provider, or a provider of the same specialty, in the same group practice within the past three years. Report follow-up visits with your new neurologist with an established-visit code, (9921x, Office or other outpatient visit for the evaluation and management of an established patient ...)

Heads up: A patient could be considered new if never seen by a provider of the same specialty within the past three years, even though they have seen different specialty physicians in a multi-specialty group within the past three years. (See the decision tree in the front of the CPTmanual.)

The outpatient consultation codes (99241-99245) are not affected by new or established patient criteria. If your new physician is asked for his opinion or advice about a patient from an appropriate source, and all consult requirements are met, then you may bill 9924x (Office consultation for a new or established patient, which requires these 3 key components ...).