Neurosurgery Coding Alert

You-ll probably call on office E/M codes for -second opinions- The AMA has decided to delete follow-up inpatient consult codes (99261-99263) and confirmatory consultation codes (99271-99275) for CPT 2006. The most significant change for neurosurgery practices will be that you-ll report all inpatient follow-up visits as subsequent care. Forget Consult Criteria for Hospital Follow-ups Beginning Jan. 1, 2006, you should report all facility visits, except the first, during the same inpatient stay using subsequent care codes 99231-99233 (hospital) or 99311-99313 (nursing facility).

Under current guidelines, the surgeon may report a follow-up inpatient consultation for subsequent visits during a single inpatient stay, as long as the visit meets the criteria of request and reason, opinion rendered and report, says Suzan Hvizdash, BSJ, CPC, physician education specialist for the surgery department at UPMC Presbyterian-Shadyside in Pittsburgh. The elimination of 99261-99263 for 2006 means that beginning in January, you-ll no longer have that option--even if the service meets the requirements of a consult and the surgeon does not assume responsibility for any portion of the patient's care.

Initial consult codes are still valid: Be aware, however, that you will still be able to report an initial inpatient consult (99251-99255) for the surgeon's first visit with the patient per inpatient stay, as long as the service meets all the requirements of a consult, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.

Example: The neurosurgeon sees an inpatient suffering injury from an auto accident at the request of the patient's managing physician. The surgeon documents the request, examines the patient and shares his findings with the managing physician.

In this case, report an initial inpatient consult code (for example, 99254, Initial inpatient consultation for a new or established patient ...).

The next day, the managing physician again asks the surgeon to examine the patient because of new symptoms. Once again, the neurosurgeon documents the request, examines the patient and shares his findings.

For the follow-up visit beginning in January, you should claim subsequent hospital care (for instance, 99232, Subsequent hospital care, per day, for the evaluation and management of a patient ...). Although this visit looks like a consult, you must report subsequent care because 99261-99263 will not be valid for 2006. Change Is Good The good news: Deletion of 99261-99263 will ease documentation requirements for physicians and headaches for coders trying to choose between follow-up consults  and subsequent hospital care, Hvizdash says. You can simply choose 99231-99233 for hospital inpatients or 99311-99313 for nursing facility patients.

-I-m happy to see [the follow-up consult codes] go,- Hvizdash says. -They-ve been such a confusing topic for a lot of physicians, especially new ones.-

Even better news: As a bonus, subsequent hospital care codes generally reimburse better than [...]