Neurosurgery Coding Alert

No need to fret over applying proper codes with this guidance.

Take a quick refresher on two E/M service items that could cause claim delays if you're not up to speed on how to factor in your neurosurgeon's time spent on inpatient discharges and how to report phone use.

1. 99239: Count All Relevant Time on Discharge Day

Question: The physician admitted a patient and then discharged the patient five days later. Before discharging the patient from the hospital, the physician spent more than 30 minutes examining the patient as well as giving instructions for continuing care and medication to her family. Should I bill 99239?

Answer: You may report 99239 (Hospital discharge day management; more than 30 minutes) provided your physician's documentation indicates the floor time (the time the physician spent preparing and dictating the discharge summary) and what the physician did.

E/M guidelines indicate that you should use 99239 "to report the total duration of time spent by a physician for final hospital discharge of a patient." Services may include examining the patient, discussing the stay, instructing caregivers on continuous care, and the related paperwork, such as the discharge records, prescriptions, and referral forms, the guidelines state. When you calculate the time involved on discharge day, remember that CPT says the time doesn't need to be continuous.

Reminder: You would use 99221 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components...) for the initial hospital care work.

2. 99441-99443: The Hard Truth About Phone Call Pay

Question: Another physician told my surgeon that he's receiving payment from his contractor for telephone calling codes. My surgeon would like to start using these codes as well. Does Medicare pay for telephone calls?

Answer: Medicare considers telephone call codes 99441-99443 (Telephone E/M service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; ...) to be non-covered services.

Here's how you know: You can find a code's status in column D of the Medicare Physician Fee Schedule.

Silver lining: Your physician technically is getting paid for telephone calls made in relation to performed office visits. "The physician work resulting from telephone calls is considered to be an integral part of the pre-service and post-service work of other physician services, and the fee schedule amount for the latter services already includes payment for the telephone calls," according to the Medicare Benefit Policy Manual, Chapter 15, Section 30 (Physician Services), Subsection B, Telephone Services (www.cms.gov/manuals/Downloads/bp102c15.pdf).

The relative value units for office visits include time for work that is spent before and after the visit on items like pulling the chart, reviewing lab results, and calling the patient. Since the fee schedule includes relative values for 99441-99443, some private and other public payers may pay for the codes, but remember that the guidelines are very specific for reporting these codes. The patient must be established to the practice, must have initiated the call to the physician, and the information discussed cannot be directly related to a visit seven or less days before the phone call. Also, the call cannot take place when the patient makes an appointment to see the physician regarding the health issue within 24 hours.