Neurology & Pain Management Coding Alert

Follow these 3 steps to start a successful claim Almost half of diabetes patients have diabetic neuropathy (a nerve disorder caused by the disease), which means they can come to your neurologist for care. Keep these three steps in mind when you-re faced with coding their care. 1. Determine Whether It's a Consult or Referral Patients with diabetic neuropathy lose sensation in their feet (and possibly hands) and have foot pain and weakness. The condition can move slowly, taking years to lead to conditions such as foot muscle weakness. Occasionally, the condition flares and affects a specific nerve, causing additional weakness or pain.

An endocrinologist will manage the patient's care as long as he feels comfortable doing so. But the condition often reaches the point where the endocrinologist might refer the patient to a neurologist or pain management specialist for advice or specific care.

Visit check: If the patient's initial visit to your physician qualifies for an office visit code, start by determining whether it qualifies as a consult or referral. A consult happens when the neurologist sees the patient and recommends something related to treatment. A referral, on the other hand, happens when another physician (an endocrinologist, in this case) sends the patient to your neurologist for treatment.

Consult coding: Report a new or established patient office consultation with the appropriate choice from 99241-99245 (Office consultation for a new or established patient ...). If your neurologist performs the consult in the hospital, choose from 99251-99255 (Inpatient consultation for a new or established patient ...) instead.

Referral choices: If the patient encounter is a referral instead of a consult -- meaning that your neurologist will take over the patient's care -- choose your code from 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient ...) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...). 2. Verify the Type of Pain When you-re coding for diabetic neuropathy treatment, you should understand the type of pain the patient is experiencing. Neuropathic pain can have up to three different components, says Barbara Johnson, MPC, CPC, owner of Real Code Inc. in Moreno Valley, Calif.:

- Ongoing pain that is continually present regardless of what the patient does or does not do

- Spontaneous pain episodes that suddenly appear without any identifiable stimulus

- Hyperalgesia, in which the patient has pain from an external stimulus that normally causes little or no pain (such as heat or cold). In addition to being categorized by the type of pain experienced, the affected body area also helps classify diabetic neuropathy. These include:

- Peripheral neuropathy, which causes pain or loss of feeling in the toes, feet, [...]