Neurology & Pain Management Coding Alert

Under-reporting 99232 and 99233 can raise red flags for payers Subsequent hospital care ranks among the top ten codes neurologists report to Medicare. But if you don't know how to distinguish the different interval history levels for 99231-99233, you could be setting yourself up to lose money and become a bulls-eye for auditors. According to CMS, the OIG has noted problems with certain procedure codes for the past several years. Codes 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of moderate complexity) and 99233 ( . . . a detailed interval history; a detailed examination; medical decision making of high complexity) have come under the microscope of many payers, who may question the medical necessity of a 99231 ( . . . problem focused interval history; problem focused examination; medical decision making that is straightforward or of low complexity) encounter. Let our experts show you how to get on your way to proper coding with these interval history insights. Is Your Neurologist Getting His Money's Worth? Inaccurate reporting of E/M services can under-compensate your neurologist if his services required more work and risk than what you bill, says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver. Additionally, she says, reporting a single E/M service level, especially if always the lowest level, can raise a "red flag" for payers and potentially increase your risk of documentation review. Improve Your Neurologist's Documentation "Education with providers is key," says Marianne Wink, RHIT, CPC, ACS-EM of the University of Rochester Medical Center, New York. If you consistently see low level codes and documentation that appears inadequate, the best course of action is to educate providers on the importance of good quality clinical documentation, she says. Remember: Inadequate clinical information in a note is a disservice to a patient and his continued care. Inadequate documentation also results in revenue loss for a physician if you have to report a lower code. Check out the examples below to help select the best code. Know Your Interval History All three subsequent hospital care codes in the CPT manual include an "interval history" as one of the three possible components used to determine correct reporting. Remember: You choose subsequent hospital care codes based on two of three key components: interval history, exam and medical decision making. Because subsequent care codes are one of the few places you-ll find the "interval history" component (instead of the usual "history"), you need to be sure you understand exactly what to look for to choose the proper code. Definition: Interval history refers to any [...]