Neurology & Pain Management Coding Alert

Question: If the neurologist does a confirmatory consult for a brain tumor on a patient who does not reside in the country, can the neurologist charge at a higher-than-normal level? What code would be used?

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Answer: Laurie Castillo, MA CPC, president of Physician Coding and Compliance Consulting, a physician consulting firm in Manassas, Va., and a coding expert in neurology, says that confirmatory consultations codes (99271-99275) are used to report a second or third opinion or advice. These codes should not be used when a physician requests the opinion/ advice. The fact that the patient is from another country does not constitute a higher charge. The three key components must be met in the documentation to substantiate a level of service.

Note: See the story Increase Payment for Consults by Showing No Transfer of Care on page 75 in the October issue of Neurology Coding Alert for more information on the specific requirements to code a consultation.

If more work is involved because the patients records are not present or additional records are reviewed from a previous encounter with a different physician, the level of medical decision-making may be higher, which may affect the overall level of confirmatory consult provided.