Neurosurgery Coding Alert

Question: May I report 90846 if the neurosurgeon meets with a patient's family to discuss treatment options, care, and questions regarding the patient?

North Carolina Subscriber

Answer: No, you may not report 90846 (Family psychotherapy [without the patient present]) for such services. This code is specific to psychiatric services and does not properly describe time the physician spends discussing the patient's condition.
 
Rather, you may choose from either the new (99201-99205) or the established patient (99211-99215) E/M codes, as appropriate. If counseling and/or coordination of care consumes more than 50 percent of the physician's time spent face-to-face with the patient and/or family, you may consider time as the controlling factor to qualify for a particular level of E/M services, according to CPT. This can include time the surgeon spent with parties who have assumed responsibility for the patient care or decision-making whether they are family members or not.
 
For example, the physician spends 30 minutes counseling an established patient's family regarding proper care for a patient with a disabling neurological condition. Consulting CPT, you will see that the reference time for 99214 is 25 minutes. In this case, the physician has spent the entire 30-minute visit in counseling. You are justified in choosing 99214 as long as the physician has properly documented this time. Some payers (such as Medicare) do require the patient to be present.
 
If the physician first meets the patient for a 15-minute examination, then calls in the family for an additional 30 minutes of counseling, you may report 99215 regardless of the level of history, exam and medical decision-making. In this case, the visit lasted 45 minutes (the reference time for 99215 is 40 minutes), and the physician spent the majority of the visit providing counseling and co-ordination of care. Therefore, time is the deciding factor.
 
Remember: The physician must document the extent of counseling and/or coordination of care in the medical record. As a "best practice," you should note the start and stop times for the visit, the total amount of time he spent in counseling and/or coordination of care, as well as the issues he discussed. In this way, you demonstrate to the payer that time was indeed the deciding factor in choosing the E/M level reported.