Neurology & Pain Management Coding Alert

You-ll treat -second opinions- like any other E/M service The AMA will streamline E/M coding by deleting follow-up inpatient (99261-99263) and confirmatory (99271-99275) consultations for CPT 2006.

What will the changes mean to your neurology practice? For starters, you-ll report all inpatient follow-up visits as subsequent hospital care. Don't Sweat Consult Criteria for Hospital Follow-ups Beginning Jan. 1, 2006, you should report all facility visits, except the first, during the same inpatient stay using subsequent care codes 99231-99233 (hospital) or 99311-99313 (nursing facility).

Under current guidelines, the neurologist may report a follow-up inpatient consultation for subsequent visits during a single inpatient stay, as long as the visit meets the criteria of request with reason, opinion rendered, and report, says Suzan Hvizdash, BSJ, CPC, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh. The elimination of 99261-99263 for 2006 means that beginning in January, you-ll no longer have that option--even if the service meets the requirements of a consult and the neurologist does not assume responsibility for any portion of the patient's care. Initial Inpatient Consults Are Still Valid You should still report an initial inpatient consult (99251-99255) for the neurologist's first visit with the patient per inpatient stay, as long as the service meets all the requirements of a consult, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.

Example: The managing physician requests that your neurologist provide a consultation for a hospital inpatient complaining of generalized numbness and loss of skin sensation (782.0, Loss of skin sensation), especially in the lower limbs. The neurologist documents the request, examines the patient and shares his findings with the managing physician.

In this case, report an initial inpatient consult code (for example, 99254, Initial inpatient consultation for a new or established patient ...), as well as any diagnostic tests the neurologist provides (for example, 95864, Needle
electromyography; four extremities with or without related paraspinal areas).

Don't forget: You-ll need to append modifier 26 (Professional component) to any diagnostic tests that the neurologist provides in the hospital setting.
 
The next day (let's call it Jan. 3, 2006), the managing physician again asks the neurologist to examine the patient because of new symptoms. Once again, the neurologist documents the managing physician's request, examines the patient and shares his findings. For the follow-up visit, you should claim subsequent hospital care (for instance, 99232, Subsequent hospital care, per day, for the evaluation and management of a patient ...). Although this visit looks like a consult, you must report subsequent care because codes 99261-99263 will not be valid for 2006. Don't Worry ... Be Happy Some good news: Deletion of 99261-99263 will ease documentation requirements for physicians and headaches for coders trying to [...]