Neurology & Pain Management Coding Alert

Question: Our neurologists do inpatient consultations (especially the ICU) and spend a lot of time with counseling and coordination of the patient’s neurologic care. Because of the amount of time that they spend with the patients and family, they want to bill based on counseling and/or coordination of care. However, the services are done with residents and, according to the teaching physician guidelines, the resident time along with the patient is not counted unless the resident is with the teaching physician performing the service. 

The neurologists want to do a linking statement for the resident participation and also another statement regarding the time spend in counseling and coordination of care. Is this allowed? 

North Dakota Subscriber 

Answer: Any time spent by the resident in the absence of the teaching physician is not counted.  In an inpatient setting, when more than 50 percent of the total visit time by the teaching physician is counseling and/or coordinating the patient’s care, the time used to code must be provided at the patient’s bedside and/or on the patient’s hospital floor or unit.  

When coding based on time, the teaching physician may not:

• Add time spent by the resident in the absence of teaching physician to face-to-face time spent with the patient by the teaching physician with or without the resident present. 

• Count time counseling or coordinating the patient’s care after leaving the patient’s floor or after beginning to care for another patient. 

A linking statement for the care is not sufficient to support the teaching physician billing for the resident’s unattended time counseling the patient. The teaching physician must document his/her presence or participation in the services for the period of time for which the claim is made. As a general rule, if a resident participates in a service provided in a teaching setting, the teaching physician may not bill Medicare Part B for services unless the teaching physician is present during, or personally performs, the key portion of any service for which payment is sought.