Neurology & Pain Management Coding Alert

You'll need separate symptoms to get around this reporting limitation

If you work in a large neurology practice with multiple physicians, you will need to pay attention to a recent clarification from CMS.

CMS reported in transmittal 731 that it won't pay for multiple evaluation and management services provided on the same day by physicians in the same practice and same specialty--unless the visits are for unrelated problems.

In a nutshell: If your doctor sees the patient in the office and again in the emergency department on the same day, or sees a patient in the office and then performs an initial hospital service, Medicare will only pay for one E/M code unless you can prove the visits are for two different problems, says Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Tinton Falls, N.J., and National Advisory Board member of the American Academy of Professional Coders.

Reality check: Sometimes carriers won't pay for same-day E/Ms even when they-re for unrelated problems, but CMS has instructed carriers to pay for repeat visits in this instance. If you come across denials for multiple same-day E/Ms, and both your documentation and ICD-9 coding support different presenting symptoms, consider appealing to your carrier.

Understand Intent and Application of Ruling

CMS issued this clarification to prevent -abuse by physician groups in which members sub-specialize,- says Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the AAPC National Advisory Board.

Example: A young patient visits a pediatric neurology practice to discuss recent -zoning out- episodes, in which  the child is nonresponsive for several seconds but has no memory of the event. He first meets with a general pediatric neurologist, and later that day he returns to the practice to be examined by a pediatric epileptologist.   CMS- clarification means that you can only report a single E/M code in this case, because both E/M services are addressing the same symptoms.

Exception: You may be able to bill for two E/Ms in the same day if the patient has a -sudden onset- of a condition. Consider the following example:

An established patient attends an appointment for migraine pain. Later in the day, your physician sees the same patient in the emergency department for vertigo and light-headedness. In this case, you could report separate E/Ms because the second set of symptoms may not be directly related to the reason for the first encounter.

-The symptoms may appear to be close, but they generated two visits. It would stand to reason that the second visit could be a -sudden onset- of a condition not present during the first encounter,- Parman says.