Wiki Billing Consults

[candygirl160]

A pt was seen in 2008 for a consult. Pt comes back in 2010 to the same provider's office for another consult BUT saw another provider within that office and it is a different problem than in 2008. Can we bill a new pt consultation for provider #2 since the pt is coming in with a new problem?

 

[FTessaBartels]

Consults

Consultation codes do NOT distinguish between new and established patients.

If it's a consultation, it's a consultation. The only difference is inpatient vs outpatient.

Now ... IF the patient is covered by Medicare ... you will bill for an established patient office visit (patient seen by a provider of same specialty, same practice within the last 3 years).

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[candygirl160]

Thanks!

 

[us063958]

I thought you needed to bill as a consult to Medicare, get denied, then bill as an est pt. If audited, isn't billing an est pt first incorrect and considered billing for reimbursement?

 

[mhstrauss]

I thought you needed to bill as a consult to Medicare, get denied, then bill as an est pt. If audited, isn't billing an est pt first incorrect and considered billing for reimbursement?

No. If you are aware the patient has Medicare, or any other carrier that no longer accepts the consult codes, before you file the claim, then the correct code (either estab or new patient) should be selected from the beginning.