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: Our neurologist administers oxygen for cluster headaches and migraines, but we don't know how to bill for the oxygen. Is there a code for this?
Nevada Subscriber     Answer: It sounds as though you want to simply bill for the oxygen itself and not the administration of the oxygen, so you are on the right track. Administering oxygen would be included in the office visit (99211-99215 for established patients; 99201-99205 for new patients), although you may be able to increase the level of service if the patient's migraines require significant additional care or time spent (in which case you may be able to bill according to time). If this is the case, be sure to have the neurologist document every visit that he or she makes to the exam room, even if it is for less than five minutes. During the oxygen therapy, the time may add up significantly. If counseling or coordination of care comprise more than 50 percent of the physician/patient encounter, CPT allows billing based on the amount of time spent. For example, if the neurologist normally bills a 99212 for the oxygen visit, but spends 25 minutes discussing the oxygen administration with the patient and staying with her while administering it, he may be able to increase the level of service to a 99213 or 99214.
The oxygen itself will be coded using the most appropriate HCPCS code in the series from E0424 through E0450. It's most likely that you are using a portable gaseous oxygen system, in which case the appropriate code would be E0443.