Neurology & Pain Management Coding Alert

If another physician provides initial care for the stroke victim (in the emergency department or hospital floor) and requests that the neurologist evaluate the patient for t-PA (37195, Thrombolysis, cerebral, by intravenous infusion), you may be able to report an inpatient consultation (99251-99255, Initial inpatient consultation for a new or established patient ...; or 99261-99263, Follow-up inpatient consultation for an established patient ..., as appropriate) rather than the subsequent hospital care codes.
 
Don't forget the "Three R's": Remember, to qualify as a consult, the service must meet three minimum requirements: There must be a Request from another physician for a consult, an opinion Rendered by the consulting physician, and a written Report on the patient's condition sent to the requesting physician.
 If you meet these requirements, the neurologist may initiate treatment (such as ordering a CT scan or t-PA) and still claim a consult, says Marvel Hammer, RN, CPC, CHCO, a consultant with MJH Consulting in Denver.
 
CMS transmittal R1644.B3 (effective Aug. 26, 1999) clarified that Medicare will pay for a consult regardless whether the consulting physician initiates treatment, as long as all consultation criteria are met.