Neurology & Pain Management Coding Alert

2 expert scenarios help hone your E/M coding skills Before you report any E/M procedures, look for documentation details on the patient's presenting illness because this information can make or break your patient's complete history -- and affect your coding and your neurologist's bottom line.

Check out the following two frequently asked questions to determine your review-of-systems (ROS) savvy. Then check your answers against our experts- opinions on how to deal with the situations. Don't Let Language Barrier Keep You From Full HPI Question 1: A new patient who cannot speak English and explain her medical problems presents to your neurology practice. The patient's inability to communicate prevents your physician from obtaining a complete history of present illness (HPI) and ROS from her. Your physician treats the patient's migraine but cannot develop a definite plan for her treatment.

The neurologist calls the patient's previous two physicians to discuss her medical problems and discovers that the patient also has a history of stroke and seizure. Your neurologist spends a total of 90 minutes on this patient on the same day, including face-to-face patient time and telephone calls to the other providers. 

How should you charge for this scenario? Which E/M codes and modifiers should you use to justify the extra time your physician spent on the phone with other physicians on this patient's behalf?

Answer 1: You should select the appropriate E/M service level from 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient ...) based on the information your physician obtained from the patient and her previous physicians.

Be careful of time: If you want to bill based on time, the physician must spend more than 50 percent of the total face-to-face time counseling and/or coordinating care with the patient. If your physician's encounter does not meet this requirement, you cannot bill based on time.

Watch out: In most cases, you cannot bill based on time if a communication barrier extended your physician's face-to-face time with the patient. Normally, communication barriers do not meet the criteria for counseling/coordinating care.

The neurologist may document the excessive effort in trying to obtain an appropriate history with the reason for the excessive effort and a reason why he was unable to get the full history. The physician may receive credit for the -unobtainable- history.

If the physician documents his service time when the patient is not physically present (such as this physician's postexam calls to the patient's other physicians), you will probably be unable to report this time to most payers, says Heather Corcoran, coding manager at CGH Billing in Louisville, Ky.

Here's why: Most payers consider extra time (as in this example) to be part of the pre- and [...]