Inpatient Pain Consult Billing Questions as a PM&R/Pain trained doc

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milomoneepood

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Hello,

I am a fairly new attending, PM&R/Pain, in South Florida working as an independent contractor under a big group. I am now trying to establish inpatient pain consults to see patients under my own LLC group to supplement income. An experienced PM&R/Pain physician recently told me that if I see an inpatient consult patient for Pain Management on a day when a PM&R physician also sees the same patient on the same day, because I am PM&R/Pain (unlike Anesthesiology/Pain or “non-PM&R Pain), the payers would consider it as double billing as 2 PM&R doctors and I may not be paid. Is that true? It didn’t make sense because then an IM sub-specialist (ex. GI) shouldn’t be able to do an inpatient consult on a patient who has an IM hospitalist or if another IM sub-specialist (ex. Pulm) is seeing the same patient the same day.

Does this mean I as PM&R/Pain cannot do Pain consults at an inpatient rehab facility where PM&R doctors see patients as primary everyday??



I asked my billing company for clarification. After their research, they confirmed that if I happen to render Pain consult service on the same day when another PM&R sees the same patient - I should be okay as long as I:

(1) Document my note describing my care plan that clearly shows that it is for Pain (not PM&R)

(2) Categorize/Label my note properly under Pain Management (and not PM&R)

(3) Document that I am rendering my consult service specific to the Pain consult referral from the hospitalist

(4) Am not in the same group as the other PM&R doctor doing PM&R consult on the same patient


Do they sound correct?


***Also - what CPT codes do you use for Initial consult and Follow-Up consult?

As a rough guideline, I was recommended to use 99254 for Initial inpatient consultation and 99232 for Follow-Up inpatient consultation, but apparently the inpatient consultation codes may not be recognized for much longer? I also would like to ensure that I used the right codes for billing.


Thank you very much in advance!
 
no, if you are seeing patients under Pain (assuming full credentialling as a Pain physician), there would be no issues.

what the billing company told you is what i have been told multiple times by other sources, including separate HOPD billers/coders from 2 separate institutions.

what i have used for inpatient consultation:

Initial consult, inpatient or obs level:
level 1 (40-54 min) 99221
level 2 (55-74 min) 99222

subsequent
level 1 (25-34 min) 99231
level 2 (35-49 min) 99232

i have not used 99251-4 (fwiw, 99254 is 80 min), but havent gotten clarification whether to use those codes. ill ask coders. there is a difference in rvus (1.63 vs 2.72)
 
the taxonomy code for PMR (208100000X) is different from the taxonomy code for PMR Pain Medicine (2081P2900X), which is different from just Pain medicine (208VP0000X), Interventional Pain Medicine (208VP0014X) and Anesthesiology Pain Medicine (207LP2900X)...


apparently according to that website, these are self reported so i dont know if you should affix them to your notes, or if you should just make sure your billers use the correct one.
 
Hello,

I am a fairly new attending, PM&R/Pain, in South Florida working as an independent contractor under a big group. I am now trying to establish inpatient pain consults to see patients under my own LLC group to supplement income. An experienced PM&R/Pain physician recently told me that if I see an inpatient consult patient for Pain Management on a day when a PM&R physician also sees the same patient on the same day, because I am PM&R/Pain (unlike Anesthesiology/Pain or “non-PM&R Pain), the payers would consider it as double billing as 2 PM&R doctors and I may not be paid. Is that true? It didn’t make sense because then an IM sub-specialist (ex. GI) shouldn’t be able to do an inpatient consult on a patient who has an IM hospitalist or if another IM sub-specialist (ex. Pulm) is seeing the same patient the same day.

Does this mean I as PM&R/Pain cannot do Pain consults at an inpatient rehab facility where PM&R doctors see patients as primary everyday??



I asked my billing company for clarification. After their research, they confirmed that if I happen to render Pain consult service on the same day when another PM&R sees the same patient - I should be okay as long as I:

(1) Document my note describing my care plan that clearly shows that it is for Pain (not PM&R)

(2) Categorize/Label my note properly under Pain Management (and not PM&R)

(3) Document that I am rendering my consult service specific to the Pain consult referral from the hospitalist

(4) Am not in the same group as the other PM&R doctor doing PM&R consult on the same patient


Do they sound correct?


***Also - what CPT codes do you use for Initial consult and Follow-Up consult?

As a rough guideline, I was recommended to use 99254 for Initial inpatient consultation and 99232 for Follow-Up inpatient consultation, but apparently the inpatient consultation codes may not be recognized for much longer? I also would like to ensure that I used the right codes for billing.


Thank you very much in advance!
No it’s not true.
 
Hello,

I am a fairly new attending, PM&R/Pain, in South Florida working as an independent contractor under a big group. I am now trying to establish inpatient pain consults to see patients under my own LLC group to supplement income. An experienced PM&R/Pain physician recently told me that if I see an inpatient consult patient for Pain Management on a day when a PM&R physician also sees the same patient on the same day, because I am PM&R/Pain (unlike Anesthesiology/Pain or “non-PM&R Pain), the payers would consider it as double billing as 2 PM&R doctors and I may not be paid. Is that true? It didn’t make sense because then an IM sub-specialist (ex. GI) shouldn’t be able to do an inpatient consult on a patient who has an IM hospitalist or if another IM sub-specialist (ex. Pulm) is seeing the same patient the same day.

Does this mean I as PM&R/Pain cannot do Pain consults at an inpatient rehab facility where PM&R doctors see patients as primary everyday??



I asked my billing company for clarification. After their research, they confirmed that if I happen to render Pain consult service on the same day when another PM&R sees the same patient - I should be okay as long as I:

(1) Document my note describing my care plan that clearly shows that it is for Pain (not PM&R)

(2) Categorize/Label my note properly under Pain Management (and not PM&R)

(3) Document that I am rendering my consult service specific to the Pain consult referral from the hospitalist

(4) Am not in the same group as the other PM&R doctor doing PM&R consult on the same patient


Do they sound correct?


***Also - what CPT codes do you use for Initial consult and Follow-Up consult?

As a rough guideline, I was recommended to use 99254 for Initial inpatient consultation and 99232 for Follow-Up inpatient consultation, but apparently the inpatient consultation codes may not be recognized for much longer? I also would like to ensure that I used the right codes for billing.


Thank you very much in advance!

How much would you be getting paid to do these and what are the hospital’s expectations in terms of your availability?
Ask yourself if the juice is really worth the squeeze.
 
For PM&R/Pain associated taxonomies under my NPI, I “self-reported”

- Pain Medicine
[] Taxonomy code: 2081P2900X
[] Provider Type: Physician/Physical Medicine and Rehabilitation
[]Specialty Code 25

- Interventional Pain Medicine
[] Taxonomy code: 208VP0014X
[] Provider Type Physician/Interventional Pain Management
[] Specialty Code 25

- Physical Medicine & Rehabilitation
[] Taxonomy code: 208100000X
[] Provider Type: Physician/Interventional Pain Management
[] Specialty Code 25


For now I listed Pain Medicine (2081P2900X) as my primary specialty.

Maybe because of overlapping “Specialty Codes” between Pain Medicine and PM&R, it can be considered double billing even if I go as Pain with another physiatrist going as PM&R?

I wasn’t aware of all these codes, so I would need to just reconfirm with my billing company for clarification again; but if anyone is experienced with or is aware of this being an issue for billing for Pain when another PM&R is going, it would be much appreciated for insight.

IMG_5337.png
 
***Typo on Taxonomy Info:

Pain Medicine Specialty Code 25 (Provider Type: Physician/Physical Medicine and Rehabilitation)

Interventional Pain Medicine Specialty Code 09 (Provider Type: Physician/ Interventional Pain Management)

Physical Medicine and Rehabilitation Specialty Code 25 (Provider Type: Physician/Physical Medicine and Rehabilitation)
 
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