Neurology & Pain Management Coding Alert

Question: Our neurologist provided consultant services to a patient who was under critical care in the ICU. The primary attending doctor was the primary attending clinician. Can we report the critical care codes for our neurologist's services?

New Mexico Subscriber

Answer: To report critical care services, you have an option of 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes [List separately in addition to code for primary service]) depending upon the time for the evaluation and management.

You will need to be specifically clear for the primary attending doctor. It isn't clear in your question if the primary attending doctor was the hospital intensivist or was the internal medicine physician. Verify the situation with the primary attending clinician since you won't be able to report 99291 if another neurologist from your group practice attends to the same patient on the same calendar date. However, you can bill for your neurologist's services if the primary attending clinician and your neurologist are from different specialties and you can document that the services meet critical care requirements, i.e., there was a medical rationale for the service and it was non-duplicative.

Medicare specifies 'while more than one physician may provide critical care services to a patient during the critical care episode of an illness or injury, each physician must be managing one or more critical illness(es) or injury(ies) in whole or in part. When the group physicians are providing care that is unique to his/her individual medical specialty and managing at least one of the patient's critical illness(es) or critical injury(ies) then the initial critical care service may be payable to each.'