pbdas1
Contributor
Are the 3 R's still required for payers that do not recognize Consult codes if the intent is a consult?
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Wiki 3 R's needed?
- Thread starter pbdas1
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Orthocoderpgu
True Blue
If the three R's are not met, there is no consult. Something to keep in mind. CMS audited consultation codes and the error rate was 95%. So CMS teamed up with AAPC to make coders aware of the documentation requirements. After three years of educating coders on the proper documentation requirements, the error rate stayed the same which is why CMS stopped paying for consultations.
jkyles
True Blue
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Hi there, interesting question.
The 3 R's only apply when you submit a consult code. Otherwise you just need to make sure the documentation supports the E/M code you are reporting.
For example:
Mr. Patient goes to Dr. B and says they were referred by Dr. A for a consult.
B examines the patient and sends a report back to A. The patient's insurance doesn't cover consults, B bills a 99203 for the visit.
Later B's practice realizes it doesn't have a record of a verbal or written request by A.
It doesn't matter because office/outpatient visits don't require a request by another provider.