Neurosurgery Coding Alert

Are you still not sure what separates a consult from a transfer of care or referral? Or do you think you've got it down? Take this quick quiz to test your knowledge.
 
Scenario 1: The patient sees his primary-care physician (PCP) to complain about sharp pain in his neck. The patient suspects he may have injured himself in a minor parking-lot accident. The PCP offers the patient advice to alleviate the pain and recommends that the patient see a neurosurgeon for a spinal evaluation as soon as possible. Three days later, the patient sees the surgeon, who diagnoses the patient with a herniated cervical disk.
 
Consult or transfer of care/referral?
 
Solution 1: In this case, you cannot claim a consult because the visit does not meet the minimum requirements of request, review and report, Hammer says. Although the PCP recommended that the patient see the surgeon, he did not specifically request that the surgeon see the patient, nor did the surgeon report his findings back to the PCP. You should report an appropriate-level new patient office visit (for example, 99204, Office or other outpatient visit for the evaluation and management of a new patient...), as supported by the surgeon's documentation.
 
Scenario 2: A patient's PCP requests that the surgeon see the patient with a complaint of headaches, nausea, dizziness and other signs and symptoms indicative of a brain aneurysm. The neurosurgeon examines the patient for 40 minutes, taking the patient's history, performing an exam and deciding to order an imaging scan - which does not reveal a more serious problem. The surgeon discusses his findings with the patient, notes them in the medical record and prepares a report for the PCP outlining the findings.
 
Consult or transfer of care/referral?
 
Solution 2: In this case, you should report an office consultation, such as 99243 (Office consultation for a new or established patient ...) for the E/M portion of the visit. Although the surgeon ordered and interpreted a diagnostic imaging scan, the visit meets all the requirements of consult.
 
Be sure, also, to report the brain imaging (for example, 70546-26, Magnetic resonance angiography, head; without contrast materials[s], followed by contrast material[s] and further sequences; professional component).
 
Scenario 3: A woman meets with her neurologist and asks about her intractable carpal tunnel syndrome (354.0). The neurologist contacts a neurosurgeon colleague and requests that the surgeon evaluate the patient as a potential candidate for surgery. The surgeon meets with the patient and recommends surgery at the earliest date. The surgeon operates on the patient and performs all postoperative care.
 
Consult or transfer of care/referral?
 
Solution 3: In this case, the initial visit could be either a consult or a transfer of care, depending on documentation.
 
Although the neurologist requested that the surgeon evaluate and treat the patient, you may consider the first visit a consult only if one of the physicians documents the request in the medical record and the surgeon reports his findings back to the neurologist.
 
If the surgeon immediately accepts care of the patient, you should report a new outpatient visit (such as 99204) rather than a consult, Hammer says.