Neurosurgery Coding Alert

Question: A surgeon spent 85 minutes providing a consultation for a patient in the hospital. A minimal evaluation was performed. Most of the visit was spent reviewing an MRI, discussing the results with and counseling the patient. In this case, does time supersede all other elements of E/M coding? Would 99255 be appropriate?

Colorado Subscriber

 
Answer: CPT guidelines for 99255 (initial inpatient consultation for a new or established patient) require a comprehensive history, examination and medical decision-making of high complexity. In this case, these require-ments have not been met. However, a consult may be billed with time as the primary factor if counseling and coordinating of care comprise more than 50 percent of the visit (rounded to five-minute intervals). According to CPT, the physician typically spends 110 minutes with the patient for a level-five inpatient consult (99255). Therefore, to bill this level with time as the determining factor, at least 51 minutes would have to be spent in counseling and coordination of care. This must be face-to-face time.
 
In this instance, the consult lasted 85 minutes. If the physician spent at least 41 of these in face-to-face counseling and coordination of care, the visit would qualify as a level-four inpatient consult (99254), which has a base time of 80 minutes.
 
It is helpful to document start and stop times for the visit. Carefully specify the time spent on counseling and coordination of care, clearly indicating that more than 50 percent of the visit was spent on these activities.