Otolaryngology Coding Alert

Time-saver: You don't always need fax request proof Before you complete another fax request form or send one out, check out these two rules that will save you from spending time on unnecessary paperwork.

Recent CMS rules have created a flurry of paperwork as consulting physicians strive to provide evidence of the other physician's written request. In an attempt to reduce this time-consuming paper trail, Medicare came out with a recent clarification that may let the consultant off the hook.
 
-On April 18, 2006, the PRIT (Physician Regulatory Issues Team) released a statement indicating that they do not expect the consulting physician to verify that the ordering physician has documented the consultation request in the patient chart,- writes Diane Daigle, president of MeMGMA (Maine Medical Group Management Association).

But that statement doesn't mean you should stop using fax confirmation forms or that you shouldn't respond to other physicians- requests that you do so. Implement proper form protocol using two guidelines. Rule 1: Avoid Faxing Consult Requests to Referrals Scenario 1: We are a small ENT practice and we often refer patients to a local allergist. The allergy practice saw your April article -Use This Sheet to Coordinate Your Consult Documentation,- which recommended that otolaryngologists fax a consult request form to the requesting physician before the surgeon performs a consult. This way, the ENT ensures that he always has consult requests in writing. But this allergist faxes us the form every time we send any patient to him -- even when we are transferring care of the patient to the allergy practice. Is this necessary?


Rhode Island Subscriber
-You are best served if you have either a faxed request or a formal form that the otolaryngologist completes,- says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J. If you have already sent a consult request in writing to the allergist, you don't need to fill out another consult request form.

Do this: The only time the allergist will need to send your practice the consult request form is when one of your ENTs specifically asks the allergist to perform a consultation but fails to put his consult request in writing, Cobuzzi says. In those cases, the allergist can send your practice the form to ensure that you-ve given him clear documentation of the consult request.

If you simply refer a patient to the allergist -- meaning that your otolaryngologist transfers the patient's care to the allergist -- then from a coding standpoint, there is no need for a written request of the referral. In fact, if the allergist asks you to fill out the consult request form every time you refer a patient, [...]