Neurology & Pain Management Coding Alert

Question: What may I report if our neurologist is asked for an opinion on a patient's condition while on call for an emergency department (ED)?

Maryland Subscriber

Answer: You may report 99241-99245 (Office consultation for a new or established patient ...) for this type of consultation. Consultations may occur in any outpatient environment, including the ED, which is an outpatient site-of-service. For the service to qualify as a consultation, the treating physician in the ED must specifically request the neurologist's opinion.

Keep the consultation requirements straight with these basics. The five R's of a consultation are as follows:

- Reason: Both the requesting physician and consulting neurologist must document a medically necessary reason and request for a consultation. But the consultant doesn't have to verify that the requesting physician did so. In the hospital or where the medical record is shared, it is a good idea to verify a request for consultation versus a request for medical management, which is not a consultation (for example, transfer of care for seizure management).

- Request: The request must come from another physician or qualified nonphysician practitioner (NPP). CPT also allows requests from other appropriate sources, so check with your payers to determine what they consider valid consult request sources.

- Review and Render: The consultant must review medical records that the requesting physician may have provided and then render the history, exam and medical decision making findings. The consulting neurologist may initiate diagnostic and/or therapeutic services.

- Recommendations and Report: The consultant must issue a separate written report of his findings and/or recommendations for treatment to the requesting source. If the consulting neurologist initiates treatment, experts suggest you use the words "I have taken the liberty to begin treatment" in the report.

- Return (recommended by experts): To further show that a transfer of care didn't initially occur prior to the consultation request, the consultant should send the patient back to the referring physician after the consultation service.

Take note: In the introduction to "Office or Other Outpatient Consultations," CPT states that codes 99241-99245 "are used to report consultations provided in the physician's office or in an outpatient or other ambulatory facility, including hospital observation services, home services, domiciliary, rest home, custodial care or emergency department."