Neurosurgery Coding Alert

CPT 2006 deletes 99261-99263 and 99271-99275

If your neurosurgeon provides consultations, take note of the CPT deletions of follow-up and confirmatory consultation codes that go into effect on Jan. 1. In 2006, you won't be able to report multiple in-patient consultations during a patient's hospital stay.

CPT 2006 Also Clarifies Modifier 25

 When the 2006 CPT updates take effect Jan. 1, 2006, neurosurgeons will face two major E/M changes. CPT 2006 will:

- delete follow-up inpatient consultations (99261-99263, Follow-up inpatient consultation for an established patient -) and confirmatory consultations (99271-99275, (Confirmatory consultation for a new or established patient -)

- clarify modifier 25's (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) explanatory text to specify that documentation must support the significant and separate E/M claim.

What You Report Instead

Starting in January, you-ll bill all inpatient consults as 99251-99255 (Initial inpatient consultation for a new or established patient -). Report follow-up inpatient care with subsequent hospital care codes 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...).

In other words, you-ll only be able to claim one consult per inpatient stay. If your physician sees the patient again, you should use the subsequent hospital care codes.

How it works: When your neurologist receives a request for a consult in the inpatient setting, you may claim one initial inpatient consult (99251-99255) per visit. These codes won't change for 2006. If your physician sees the same patient during the same inpatient stay, you should report subsequent hospital care codes (99231-99233), not follow-up inpatient consult codes (99261-99263) as you do now.

Example: After a neurosurgeon renders an opinion on a patient with unexplained mental status changes, the physician continues to check on the patient during his hospital stay. Because the neurosurgeon is managing the patient's subsequent neurological care, you should code the subsequent visits with 99231-99233.

Pros and Cons of Consultation Code Deletions
 
While the 2006 deletion of 99261-99263 and 99271-99275 is sure to make your coding easier and more profitable in some ways, it may also make some aspects of your coding more complicated.

Advantage: Luckily, this change will result in a pay increase for your physician: Codes 99231 and 99233 pay $11.75 more than 99261 and 99263, based on the 2005 fee schedule. And 99232 reimburses $10.23 more than 99262.

Problematic: There is no clear answer as to which code you should use instead of the deleted confirmatory consultation codes. A confirmatory consultation could qualify as an office visit, an outpatient consultation or an inpatient consult, says Heather Corcoran, coding manager at CGH Billing in Louisville, Ky.

If the patient is seeking a second opinion before surgery and the visit meets all the requirements for a consult, bill it as an office or inpatient (99241-99245 or 99251-99255) based on the place of service, says Arlene Morrow, CPC, CMM, CMSCS, a consultant with AM Associates in Tampa, Fla. Otherwise, bill it as an office or inpatient visit (99201-99205 or 99231-99233).

To determine the appropriate code, look at the encounter's site of service and its consultation qualifications. If the visit meets a consultation's three requirements--request for opinion, rendering of services, and a report on the physician's findings--you should use a consult code.

Additional E/M CPT Changes

January's update also clarifies the requirements for  modifier 25. The new language states that documentation must satisfy -the relevant criteria for the respective E/M service to be reported.-

This solidifies most coding experts- recommendations that you should be able to lift the E/M documentation from your notes and it should stand as a completely separate service from what the surgeon performed during the procedure.

Caution: -Just because the person comes in and we do a procedure doesn't make it an automatic 25 modifier,-  Morrow says. -You have to have enough documentation of medical necessity to justify that service.-

CPT also adds codes for initial nursing facility care (99304-99306) and a miscellaneous code for -other nursing facility services,- 99318.

And you-ll have new codes for care plan oversight in home care, rest homes such as assisted-living facilities, or domiciliary: 99339-99340.