Neurology & Pain Management Coding Alert

Question: Another physician asked our neurologist for a consult with a patient who had been admitted for an observation stay. Should I report his services using initial observation codes 99218-99220?


Florida Subscriber
Answer: The initial observation code range would not be appropriate in this case. Because the neurologist is involved with the patient in a consultative capacity, you should report his services with the appropriate outpatient consultation code (99241-99245). However, if your doctor admits the patient to the hospital, you can more accurately use the applicable initial hospital care code (99221-99223).

Reason: Only one physician can bill the observation admit codes (99218-99220, Initial observation care, per day ...) per observation stay, and this code range is most likely--and rightfully as stated in CPT guidelines--used by the supervising physician. Because observation is an outpatient setting, all other physicians treating the patient should report outpatient care codes.

If you inappropriately code for initial observation, you-ll most likely find yourself in a losing race for reimbursement with the supervising physician. Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.