Neurology & Pain Management Coding Alert

Prevent denials by studying these 3 tips. If you-re confused about when and how to report consults, join the club. But our experts can help simplify your job by explaining three important issues to watch for. Key: The purpose of a consultation is for one physician to ask your neurologist for his advice, opinion, recommendation, or suggestion in evaluating or treating a patient because your neurologist has expertise beyond the requesting professional's knowledge. Keep current on how to best code consults to obtain full reimbursement. 1. Define -Consultation- "A consult is one physician saying to another, -I-d like your opinion so that I can continue to treat my patient,-" says John Verhovshek, MA, CPC, director of clinical coding communications with the AAPC in Naples, Fla. Remember, he says, that every consult needs a Request (in writing); a Reason (again, documented in the medical record) for the consult; and a Report from the consulting physician back to the requesting physician (written) that outlines findings or suggests a plan of care. In other words, a consultation can establish a diagnosis, confirm a diagnosis, or make suggestions for treatment of the diagnosis. Focus on the report: The report portion of the consult is what drives the consult. The consulting physician must provide instruction or advice to the requesting physician so that the requesting physician can continue to treat the patient, Verhovshek says. "A note saying -Thanks for the referral business- definitely won't cut it," he adds. "In the same way, the requesting physician should be prepared to act on the advice that the consulting physician provides." The requesting physician could review the consultation report and decide that management of the patient's condition is beyond his skills and send the patient back to the consulting physician for management. For example: The Medicare Claims Processing Manual, Chapter 12, Section 30.6.10.F, instructs consulting providers with documentation requirements for compliantly reporting consultation services, says Marvel J. Hammer, RN, CPC, CCS-P,PCS, ACS-PM, CHCO, from MJH Consulting in Denver. "Providers frequently dictate their consultation reports for outpatient services and commonly also for inpatient consultation services," she says.-"The consulting provider must indicate in their report who the requesting source was and the reason for the consultation service.-Some providers dictate their finding in the form of a letter to the requesting source." 2. Beware of Transfers A transfer of care often trips up coders. During a consultation, your consulting neurologist is allowed to perform diagnostic testing or even initiate treatment -- however, he must return the patient to the requesting physician for ongoing care. If the neurologist instead accepts ongoing care for the patient's condition, the visit doesn't meet the criteria for a consult. This would represent a transfer of care. Watch [...]