Neurology & Pain Management Coding Alert

Question: A 46-year-old patient reported to our hospital's emergency department (ED) early in the morning for evaluation of uncontrollable shaking in his extremities and severe pain in his neck. The emergency department practitioner (EP) evaluated the patient and ordered blood tests and a CT scan, but the shaking got worse. The EP consulted with our neurologist, who recommended the patient be hospitalized. Our neurologist admitted the patient to the hospital as an inpatient that evening for more diagnostic workup. The notes indicate a comprehensive history and exam was performed, along with moderate medical decision making. As the neurologist's coder how should I code this?

Washington Subscriber

Answer: Since it was your neurologist who admitted the patient to inpatient hospitalization, you should code 99222 (Initial hospital care, per day, for the evaluation and management of a patient ...).

You might easily confuse where your neurologist's responsibility begins and the ED physician's side of the equation ends. Although they can recommend hospitalization, ED physicians typically do not admit patients to hospital inpatient status.

The ED physician's coder will bill a 99281-9928x code (New or established patient emergency department services ...).

Diagnosis help: You'll report 781.0 (Abnormal involuntary movements) and 723.1 (Cervicalgia) to represent the patient's symptoms.

If the patient has an established diagnosis by the end of the day, you would link the diagnosis to his initial hospital care code. If only the patient's current signs and symptoms are confirmed, you would only report the ICD-9 codes for that date of service.