Neurology & Pain Management Coding Alert

Question: A neurologist in our practice was called into a hospital for a consultation on a Medicaid patient. We billed 99254 with place of service code 21. The claim was denied. I'm new to neurology coding, so I'm not sure what we did wrong. Was the POS code wrong?

Florida Subscriber

Answer: No, your place of service (POS) code of 21 (Inpatient hospital) is not a factor in this denial. The reason your claim was denied was most likely because the patient's Medicaid is following Medicare rules, which no longer allow you to use consultation codes, such as 99254 (Inpatient consultation for a new or established patient...).

You may need to instead use an initial hospital care code such as 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient ...).

The new consult code rules still trip up even experienced coders, so you're not alone in your confusion. As of January 1, 2010, CMS eliminated payment for "the use of all consultation codes (inpatient and office/outpatient codes for various places of service except for telehealth consultation G codes) on a budget neutral basis by increasing the work RVUs for new and established office visits" and for initial hospital and nursing facility visits, the Final Rule notes.

Tip: Double-check with your Medicaid carrier to confirm that they are in fact following Medicare's consult code rules. Plus, note that for any subsequent visits your neurologist makes, you'll use 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient).