Neurology & Pain Management Coding Alert

Question: Our neurologist performs EEGs in the hospital. He performs follow-up services for the patient after the initial test was done. Can we bill a follow-up visit even though the neurologist never billed for a consult because his first encounter with the patient was the test?

Alaska Subscriber

Answer: You will first need to determine if your neurologist is seeing the patient in the hospital facility or his office for "follow-up". The inpatient hospital codes are not based on new versus established in comparison to the office setting. Additionally, consultation codes are not based on new versus established patients either. One issue with consultation services would be if the patient is covered by Medicare, which doesn’t accept the consultation codes, then the physician would need to report the appropriate E/M code based on the place of service, i.e. office (new versus established) or inpatient (initial hospital care code).

To determine if the patient is new versus established to the physician when considering office based E/M service, it would be based on whether the physician had a face-to-face service with the patient within the past three years. IF the physician performed both the professional and technical components of the diagnostic EEG testing, then the patient would be considered to be established as the physician would have had a face-to-face service performing the technical portion of the EEG.

In contrast, if the physician only performed the professional interpretation component of the EEG, i.e. reviewed the EEG findings and created a report with no-face-to-face service, and the physician had not seen the patient within the past three years, the patient would potentially be considered a new patient to the physician for an office E/M code category.