Neurology & Pain Management Coding Alert

Prevent denials by studying these 3 tips.

If you-re confused about when and how to report consults, join the club. But our experts can help simplify your job by explaining three important issues to watch for.

Key: The purpose of a consultation is for one physician to ask your neurologist for his advice, opinion, recommendation, or suggestion in evaluating or treating a patient because your neurologist has expertise beyond the requesting professional's knowledge. Keep current on how to best code consults to obtain full reimbursement.

"A consult is one physician saying to another, -I-d like your opinion so that I can continue to treat my patient,-" says John Verhovshek, MA, CPC, director of clinical coding communications with the AAPC in Naples, Fla. Remember, he says, that every consult needs a Request (in writing); a Reason (again, documented in the medical record) for the consult; and a Report from the consulting physician back to the requesting physician (written) that outlines findings or suggests a plan of care. In other words, a consultation can establish a diagnosis, confirm a diagnosis, or make suggestions for treatment of the diagnosis.

Focus on the report: The report portion of the consult is what drives the consult. The consulting physician must provide instruction or advice to the requesting physician so that the requesting physician can continue to treat the patient,

Verhovshek says. "A note saying -Thanks for the referral business- definitely won't cut it," he adds. "In the same way, the requesting physician should be prepared to act on the advice that the consulting physician provides." The requesting physician could review the consultation report and decide that management of the patient's condition is beyond his skills and send the patient back to the consulting physician for management.

For example: The Medicare Claims Processing Manual, Chapter 12, Section 30.6.10.F, instructs consulting providers with documentation requirements for compliantly reporting consultation services, says Marvel J. Hammer, RN, CPC, CCS-P,PCS, ACS-PM, CHCO, from MJH Consulting in Denver. "Providers frequently dictate their consultation reports for outpatient services and commonly also for inpatient consultation services," she says.-"The consulting provider must indicate in their report who the requesting source was and the reason for the consultation service.-Some providers dictate their finding in the form of a letter to the requesting source."

A transfer of care often trips up coders. During a consultation, your consulting neurologist is allowed to perform diagnostic testing or even initiate treatment -- however, he must return the patient to the requesting physician for ongoing care. If the neurologist instead accepts ongoing care for the patient's condition, the visit doesn't meet the criteria for a consult. This would represent a transfer of care.

Watch out: Some coders may consider reporting code 99499 (Unlisted evaluation and management service) for an initial inpatient visit for your non-admitting, non-consulting neurologist who immediately assumes care for the patient.

But CPT regulations state that the initial hospital care codes (99221-99223) "are used to report the first hospital inpatient encounter with the patient by the admitting physician. For initial inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (99251-99255) or subsequent hospital care codes (99231-99233) as appropriate." The subsequent hospital care codes may not rise to your desired level of compensation, but they are the necessary choice if the visit does not qualify as a consultation.

Take note: If the documentation supports it, providers can also use the prolonged inpatient E/M service codes in addition to the subsequent hospital care codes. This may be an option for the first inpatient visit by the non-admitting physician where the requirements for consultations are not being met.

Inpatient follow-up consultation codes were deleted effective Jan. 1, 2006.-AMA stated that "In consideration of the typical use of these codes, it was found that these codes were redundant, and that other more specific E/M codes would be more appropriately reported."  The AMA CPT section guidelines for inpatient consultation services indicate that only one consultation should be reported by a consultant per admission.-Report subsequent services during the same admission using subsequent hospital care codes (99231-99233) or subsequent nursing facility care codes (99307-99310), "including services to complete the initial consultation, monitor progress, revise recommendations, or address a new problem," according to

CPT. "If the consulting neurologist is asked to see the patient again during the same inpatient admission, the physician would report his services with a code from the subsequent hospital care code range and not report a second or additional inpatient consultation service code," Hammer says.