AAN Position: Definition of Neurology Subspecialty

Background Information

The American Academy of Neurology (AAN)—an association of more than 40,000 neurologists and neuroscience professionals dedicated to providing the best possible care for patients with neurological disorders—strives to be the best resource of accurate information for neurologists in order to promote high quality, safe, and cost-effective care.

Description of Issue

Guidelines for Evaluation and Management (E/M) services define use of new and established patient visits based on whether a patient has been seen by a provider of the exact same subspecialty who belongs to the same group practice within the previous three years. For the purposes of defining the subspecialties of neurology, the AAN looks to accreditation and certification programs from ABPN, ACGME, UCNS and the Health Care Provider Taxonomy Code Set.

Since January 1, 2010 when the three year rule was implemented by the Centers for Medicare and Medicaid Services (CMS), a new patient has been defined as “a patient who has not received any professional services (E/M or other face-to-face service) within the previous 3 years.”¹ This included services rendered by a physician within the same practice setting.

The 2012 revisions to the CPT E/M Guidelines have clarified that if a patient receives services from a physician who is not of the exact same specialty as the physician rendering the initial services, the second encounter may be reported as a new patient visit.

Rationale

The American Academy of Neurology has compiled a list of neurology subspecialties to assist its membership in making the determination whether a new patient encounter may be reported using the revised decision tree. This list is not intended to be exclusive. Neurologists may refer payers to this position statement to support the validity of a reported new patient visit.

ACGME accredited subspecialties:

The Accreditation Council for Graduate Medical Education (ACGME) is responsible for the accreditation of post-MD medical training programs in the United States.

Child Neurology
Clinical Neurophysiology
Endovascular Surgical Neuroradiology
Hospice and Palliative Medicine
Neurodevelopmental Disabilities
Neuromuscular Medicine
Pain Medicine
Sleep Medicine
Vascular Neurology

Subspecialties recognized by UCNS:

UCNS is a nonprofit organization that accredits training programs (fellowships) in neurologic subspecialties and awards certification to physicians who demonstrate their competence in these subspecialties.

Autonomic Disorders
Behavioral Neurology & Neuropsychiatry
Clinical Neuromuscular Pathology
Geriatric Neurology
Headache Medicine
Neural Repair and Rehabilitation
Neurocritical Care
Neuroimaging
Neuro-Oncology

Subspecialties recognized by ABPN:

The ABPN is a not-for-profit organization that facilitates the certification and Continuing Certification (CC) processes for psychiatry and neurology.

Clinical Neurophysiology
Epilepsy
Hospice and Palliative Medicine
Neurodevelopmental Disabilities
Neuromuscular Medicine
Pain Medicine
Sleep Medicine
Vascular Neurology

Health Care Provider Taxonomy Code Set- Psychiatry & Neurology:

The Health Care Provider Taxonomy code set is an external, nonmedical data code set designed for use in an electronic environment including transactions mandated under HIPAA. The National Uniform Claim Committee (NUCC) is presently maintaining the code set.²

Behavioral Neurology and Neuropsychiatry
Clinical Neurophysiology
Diagnostic Neuroimaging
Hospice and Palliative Medicine
Neurodevelopmental Disabilities
Neurology
Neurology with Special Qualifications in Child Neurology
Neuromuscular Medicine
Pain Medicine
Psychosomatic Medicine
Sleep Medicine
Vascular Neurology

Conclusion

Neurologists of a different subspecialty who see a patient within three years of another neurologist in the same group practice should report a new patient E/M code for that visit. It is appropriate for neurologists to determine whether they are of a “different subspecialty” according to one of the designated subspecialties or other subspecialties recognized within the medical community.

Position Statement History

Reviewed by the Coding Subcommittee; approved by the Medical Economics and Management Committee on July 31, 2012; approved by the AAN Board of Directors on August 14, 2012. AAN Policy August 14, 2012.

References

1. Centers for Medicare and Medicaid Services. MLN Matters: MM6740 revised: revisions to consultation services payment policy. Available at: www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/downloads/mm6740.pdf. Accessed June 12, 2012.

2. National Uniform Claim Committee. Provider Taxonomy. Available at: http://www.nucc.org/index.php?option=com_wrapper&view=wrapper&Itemid=126 Accessed June 12, 2012.