Neurology & Pain Management Coding Alert

Question: We recently performed a consultation with findings that necessitated a spinal tap (62270, 62272) on the same day of service. We used the same diagnosis code for the consultation and the spinal tap, but Medicare rejected payment on the consultation while reimbursing for the spinal tap. How should we re-file the consultation? Each time our office queries our Medicare carrier, we speak with a different person and we are given a different answer.

S. Majmunder
Halifax Neurology Associates, PA, Greenville, N.C.

Answer: Laurie Castillo, MA, CPC, president of Physician Coding & Compliance Consulting, a physician consulting firm in Manassas, Va., and a coding expert on neurology, says that the ICD-9 code used for the consultation would be the reason for the encounter (the condition or symptom for which the primary-care physician originally sought the neurologists opinion.)

The ICD-9 code for the spinal tap may be a different ICD-9 code or the same, Castillo reports. Regardless, when performing a consultation visit on the same day as a surgical procedure, modifier -57 (decision for surgery) should be appended to the consultation code. This informs the insurance company that an evaluation and management (E/M) service resulted in the decision to perform the surgery.