Neurology & Pain Management Coding Alert

Answer: Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, says that according to the Correct Coding Initiative (CCI) edits, code 95832 (muscle testing, manual [separate procedure] with report; hand, with or without comparison with normal side) is not considered bundled into codes 95860-95870 (needle electromyography) or 95900-95904 (nerve conduction studies). It does state, however, that it is a separate procedure and can be billed so long as a separate report is created.

Technically, if a physician performs a neurology consult in the emergency room (ER) and admits the patient to the hospital, this service may be coded as either an initial patient consultation (99251-99255) or with initial hospital care codes (99221-99223). The emergency department physician probably will bill for an emergency department visit for the patients evaluation and management (E/M) services (99281-99285) leading up to the request for the neurologists consult, and the submission of code 99285 could cause concurrent care denials.

If the neurologist is performing and documenting a comprehensive history and exam, and medical decision- making of high complexity is involved, the choice would be between codes 99255 or 99223. If the medical decision-making is only of moderate complexity, the choice would be between 99254 or 99222. In either case, the consultation codes (99251-99255) pay more according to RBRVS values, so it is reasonable to bill for a consultation provided all three requirements of a consultation have been met: a documented request, indication of the advice or opinion sought by the emergency department physician, and a report of your opinion to the requesting physician.

The CPT definition of critical care codes 99291 and 99292 has changed as of Jan. 1, 2000. Previously, these codes were defined as care of the unstable critically ill or unstable critically injured patient who requires constant physician attendance. This was a very high threshold, and one that generally was not met by a great number of physicians billing critical care.

Since Jan. 1, the definition has been changed to refer to care of a critical illness or injury that acutely impairs one or more vital organ systems such that the patients survival is jeopardized. To bill for this code, the physician must perform at least one-half hour per day of direct care and attendance, although this time may include services that do not involve being at the patients bedside, such as conferences with other healthcare staff and family and analysis of complex data.

Code 99292 should be billed for each additional half hour spent beyond the initial 74 minutes; however, the final additional half-hour block of service should not be billed if the actual time spent is less than 15 minutes. There are a large number of services included in critical care that should not be billed separately (the CPT gives a complete list). Because of this lowered threshold and description, Medicare significantly reduced the relative value units (RVUs) for these codes in the current fee schedule.