Part B Insider (Multispecialty) Coding Alert

Published on Wed Aug 13, 2003 PDF

 If someone sends a patient to your surgeon, who schedules a procedure right away, then it's not going to look like a consult to auditors.
  
"Consults are always evaluation and management services," says Marcella Bucknam. "They're never procedures." So if the referring physician writes something like "Please perform a biopsy on this patient," it's automatically not a consult. The patient record for a consult should show that Dr. A sent the patient to Dr. B to see what Dr. B thinks of the patient's breast lump.
   
Likewise, Dr. B's documentation shouldn't say the patient came to Dr. B for a procedure. Instead, it should document E/M services. It should indicate that Dr. A sent the patient for another opinion, what Dr. B found, the patient's history, and other things. It should conclude by saying, "We've communicated our findings back to Dr. A, and we're going to go ahead and schedule her biopsy," Bucknam says. This has all the elements of E/M.
   
The chart should also include a letter back to Dr. A that recounts the patient's history, even though both doctors already know it. If Dr. B merely writes back to Dr. A and says, "I saw Mary Jane. She's well known to you," that won't prove a consult took place, Bucknam says. "They end up only being able to code a follow-up established patient instead of a consult, which is a huge loss of money." Instead of the $200 he might receive for a consult, the surgeon will receive only $40 to $50 for a follow-up with no history and a problem-focused exam.
   
Most otherwise healthy people who are having major surgery should have at least a level-four consult, but this rarely happens because surgeons are so bad at documenting E/M services, Bucknam says. "They don't consider that the meat of their practice," even if it could add an extra $200 to a $367 hernia surgery.
   
Even if the surgeon has already seen the patient before, he can bill for another consult if someone sends that patient to him, Bucknam says.