Neurology & Pain Management Coding Alert

You can report a new initial consult for each inpatient stay

If you're having a hard time deciding between the codes for follow-up inpatient consults and subsequent hospital care services, consider whether your neurologist assumes primary responsibility for a portion of the patient's care or if he simply provides an opinion to another physician.
 
1. Place of Service Matters If you're reporting an inpatient consultation, the patient your neurologist sees must have been admitted as an inpatient. Although this sounds obvious, mistakes occur all the time.

"Not all facility settings qualify as 'inpatient,' " says Marvel J Hammer RN, CPC, CHCO, president of MJH Consulting in Denver. "You can easily make a mistake by thinking, 'The doctor saw the patient in the hospital, so it must be an inpatient service.' But the ED [emergency department], for instance, is an outpatient setting, and doctors provide consultations in the ED all the time."

Specifically, inpatients include patients admitted to hospitals, partial hospital settings or nursing home residents.

Watch for: You should not use inpatient codes for patients the neurologist consults with in the ED, as well as domiciliary, rest (boarding) homes, custodial care or other "nonskilled" facilities. 2. Claim 1 Initial Consult per Patient Admission If you've determined that the patient qualifies for inpatient status - and the available documentation supports a consultation (see "Consults 101," later in this issue) - you should choose an appropriate-level initial inpatient consultation code (99251-99255) for the neurologist's first meeting with the patient.

Remember: "You can report 99251-99255 only once per patient per hospital stay," says Michael A. Ferragamo, MD, FACS, clinical assistant professor at State University of New York, Stony Brook.

Example: The managing physician requests that your neurologist provide a consultation for a hospital inpatient complaining of generalized numbness (782.0, Loss of skin sensation), especially in the lower limbs.
 
The neurologist meets with the patient and, after taking a history and exam, conducts electromyographic (EMG) testing (for instance, 95864, Needle electromyography; four extremities with or without related paraspinal areas). The neurologist prepares a report of his findings and shares them with the managing (requesting) physician.

In this case, you should report the initial inpatient consult (for instance, 99254, Initial inpatient consultation for a new or established patient ...) along with the EMG (95864). You should also be sure to append modifier 26 (Professional component) to 95864 because the neurologist provided the test in a facility setting.

Keep in mind: If the patient is later re-admitted to the hospital, you may report another initial consult.

Example: The patient in the above example leaves the hospital but is re-admitted three days later. The managing physician again requests a consult from your neurologist. You may again report 99251-99255, as appropriate. 3. Additional Consults + [...]