1. L

    Wiki Interprofessional Consults

    Hello, I have been going back and forth on this one question a provider asked. I hope someone can help. If a provider does an Interprofessional consult on a patient and 4 months down the road, the patient schedules an apt. to see that specialist, is that patient considered a new or established...
  2. R

    Wiki Consult and H&P

    If a provider performs a Consult on the same day as a H&P, can that provider bill a consult with modifier -57 to capture consult (when surgery is next day) and should H&P and Consult be separately reported, for auditing purposes?
  3. E

    Wiki Can we bill a consult?

    Hello! The patient presented to the ED for pain. The ED physician called our hospitalist, who by the phone recommended a diagnostic laparoscopy for possible ectopic pregnancy. The ED physician documents the patient is discharged to surgery at 1:00 PM. Our hospitalist documents her H&P at 2:45...
  4. G

    Wiki Colonoscopy Consults

    Help Please, We are struggling with finding information regarding colonoscopy consults. We are aware CMS does not allow, however there is never any discussion around a consult not performed on the same day as the procedure. For example: Patients PCP deems it time for patient to have a colo...
  5. G

    Wiki Colonoscopy Consult

    We are struggling to educate providers on appropriate level for screenings when there are no symptoms present other than patient age and or history of never having a colonoscopy. We are also questioning whether or not these types of screenings should be billed as everything we've found states...
  6. S

    Wiki Admitting Provider Specialist Consult

    Hello, my provider happened to be the "admitting provider" to sign off for a PA as no hospitalist became involved until the day after. The patient was ED the whole time as was never admitted or designated observation. The consult and procedure were brief (4 hours total) for food impaction. I...
  7. S

    Wiki Questionable 3rd R in billing a consult

    When billing a consult, is it appropriate for the consulted provider to send the report back to a provider that shares an office with the referring provider? Or does the report need to be sent specifically back to the referring provider? It's a simple case of not marking the correct, specific...
  8. C

    Wiki consult or new patient?

    1. If physician sees a patient who has paperwork that says “referral” or “transition of care” on it from the PCP or other referring provider, is this a consult or a new patient e/m? We have seen some of this paperwork have “referral” and “consult” on the same pages and my physician wants to...
  9. J

    Wiki "Consult" with a patients parent only

    Hello. I have a unique situation. My provider had a new patient appointment for a "consult" of twin girls with development issues. However this is not a true consult in that the parent initiated the appointment not a referring provider and only the parent showed up for the appointment. Is there...
  10. C

    Wiki Consult documentation requirements

    I am looking for clarification. A consultation requires the written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source. The consultant's...
  11. C

    Wiki Consult documentation requirements

    I am looking for clarification. A consultation requires the written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source. The consultant's...
  12. P

    Wiki Teaching physician attestations

    Can teaching physicians attest to notes on dates of service that they did not see the patient (as long as they state the date they saw the patient), in order to use the elements of the resident's note for coding the level of service? Example: teaching physician attests to resident's 12/1...
  13. V

    Wiki Neonatal Critical Care + Consult Codes

    Good afternoon, Scenario 1 When a neonatal patient (<28-days) requires critical care services (99468, 99469) and the critical care physician requests a consult from a physician of a different group and different specialty - what CPT would the consulting physician submit? Would the requesting...
  14. A

    Wiki consultation

    for consultation done in the E/R- If the physician knows that the patient will be admitted to either the medical floor or as an inpatient, he can use an admission code without the AI modifier correct? what if he gets admitted to observation status? I've read that a new patient (outpatient) code...
  15. D

    Wiki Correct ROS documentation

    I do coding for inpt consult and initial hosp visits. My attendings are under the impression that they should get credit for a comatose or intubated pt if the ROS are not done. How should ROS be documented in this case?
  16. D

    Wiki Inpt consultation codes (Neurology)

    When coding using pr
  17. A

    Wiki Consult code inpatient

    One provider from our group did h&p for admission, brought in cardiologist they consulted pt then requested another provider from our group see pt for consult on the day after can we bill for h&p by the one provder and a consult for the other provider or does it have to be a f/u code. H&p was...
  18. A

    Wiki Consult before Colonoscopy

    Can I get feedback on how you are billing your consults before a colonoscopy? Thank you very much for your time!
  19. J

    Wiki Two consults for the same NPI, admission to the hopsital and transfer to rehab

    Can someone clarify this for me: The patient is admitted to the hospital and we bill for the cardiology consult. Five days later the patient is transferred to the rehab floor in the same hospital and we see the patient again there due to a hematoma and he is on Coumadin. Do we bill both...
  20. S

    Wiki ER Consult Coding Clarification

    Hello Everyone! I hoping I can find some help in a situation that has come up with correct coding. So the scenario is as follows: ER doctor (Dr. A) calls in my physician (Dr. B) for a consult. Dr. B sees the patient in the ER and after this consult Dr. A decides to admit the patient. Dr. B...
  21. L

    Wiki office visit and consult code

    We had a patient come in for a office visit for constipation. during that visit the provider also did a pre op exam. Can you bill for both the E/M level and a consult code for the Pre-Op? or would you just use a E/M level?
  22. S

    Wiki established pt. - consult

    I work in an Oncology clinic and our Dr. has been seeing a pt. for Multiple Myeloma which is now in remission. His last follow-up on that problem was in Jan. of 16. He has done a Consult (99205), Jan. 2016 on the same pt. for another Dr. for a different dx. (prostate cancer). Can you charge...
  23. E

    Wiki Split/Shared IP/OP Hospital Consults

    When a PA Hospitalist performs a IP/OP consult in the hospital without the MD present. Does the MD Hospitalist have to have a face-to -face visit with the patient and also document elements of the visit in addendum to the PA's consult note that they performed personally? -or- Can the MD just...
  24. M

    Wiki specialist consult charge in hospital setting

    our specialist did a consult in the are we suppose to code it... I'm confuse, I was told not to charged 99223- range and 99231-range....I thought medicare do not accept consult charge no more.....can anyone please tell where I can get supporting documentation on how to bill...
  25. D

    Wiki Consult and Procdure question

    One of my doctors asked me the other day if he does a consult on a patient to determine if a procedure is needed can he bill for a consult and a procedure on the same day? I told him that I did not think we could bill for both. Who is correct?
  26. D

    Wiki ED Consult

    One of my physicians did a consult while a patient was in the ED on 01/09/16. Pt was admitted from the ED to IP on 01/10/16. How would I bill for the consult, as an IP or ED?
  27. N

    Wiki Inpatient admit and consult code - modifier 25?

    Patient was admitted to hospital (99221) for DVT and later that day a specialty physician for pain management did a consult (99254) which was paid. The denial is stating the 99221 is inclusive with the 99254. Is it possible to add a modifier 25 to the 99221 even though only the consult was...
  28. S

    Wiki Consult

    Can a consult be billed if the patient is referred by a PA/NP to the speciality doctor?
  29. kfrycpc

    Wiki Determining A Consult Level

    Hi all, I'm a little confused when it comes to determine the level for a consult and also for inpatient. For a consult, I know 3 of 3 have to be met. If you have a C History , C Exam and H MDM, what would the level be? For an inpatient, I know 3 of 3 must be met. But if they are not, and say...
  30. M

    Wiki New to Billing- need someone to consult with PLEASE

    Hi there, I am recently certified CPC-A as of 12/12/15 but have been working for the same substance abuse treatment center for 4 years. We recently brought in billing to be done in house (myself and my coworker). We bill for Detox, RES, PHP, IOP, OP. We also are beginning to do psychiatric...
  31. S

    Wiki Intraoperative consults

    What E/M code do you use when billing for an intraoperative consult?
  32. C

    Wiki Inpatient Consult

    If a patient was in the hospital and a consult was requested from a provider and then a month later that same provider was called in to do another consult for a new problem and the patient had been in the hospital the whole time, would you bill a new consult or subsequent visit?
  33. L

    Wiki E/M "NEW problem" on auditing forms

    I'm pretty sure that this question has been asked and answered before, but I couldn't find it. If a consulting provider sees a patient with a problem that he/she has not seen before, but that problem is not new to the primary care provider (hence the request for a consult), is that considered a...