Neurology & Pain Management Coding Alert

Question: Our neurologist was recently on-call for an emergency department. The ED physician asked for the neurologist's opinion on a patient's condition and asked the neurologist to recommend treatment options. We're considering reporting 99243. Is this the correct code for a consultation in the ED?

Nevada Subscriber

Answer: You should report consult codes 99241-99245 (Office consultation for a new or established patient) for true consultations that a neurologist provides in the ED. Many physicians and coders mistakenly believe that outpatient consults should be used for office visits only. In fact, such consultations may occur in any outpatient environment, including the ED.

The introduction to "Office or Other Outpatient Consultations" in 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."

You should only report a consultation if the neurologist meets certain criteria. The real question is, did the emergency physician request your neurologist's opinion, or did the ED physician hand the patient over to the neurologist? For the service to qualify as a consultation, the treating physician must specifically request the neurologist's opinion.

- 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; and 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.