Neurology & Pain Management Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: A parent has an appointment to show our neurologist reports on tests conducted on her minor child. The parent wants the doctor's advice on how to proceed and needs a signature to complete further testing. Should this be coded as a consultation? Oregon Subscriber


Answer: Yes, you may assign a confirmatory consultation code (99271-99275). These codes are appropriate for adults seeking a confirmatory consult for themselves or, in the case of a minor, may be conducted with the parent or legal guardian on behalf of the patient. Similarly, they may be used when adults have debilitating conditions that prevent them from making their own medical decisions and, as such, others have been legally assigned this responsibility. The neurologist's documentation should indicate clearly that the consultative services centered on the patient, even if the majority of time and counseling takes place with the patient's parent or guardian. Be aware, also, that you may have difficulty receiving payment for a confirmatory consultation under the circumstances described in your question. Confirmatory consults are usually paid if the insurer requests them but not if the patient, parents or legal guardians request them. Check with your carrier for its policy. If the insurer will not reimburse in these circumstances, inform the patient (or, in this case, the patient's family) before the consultation is performed that he or she will be responsible for payment.