Coding consults for patients that come from the ER?


Waukee, IA
Best answers
When a patient is referred to a specialist from the ER or UC,

can this be considered a consult?

Documentation requirements are the referring provider needs to be CC'd for the plan of care of the patient....
with the referring provider being an ER doctor, he wouldn't necessarily want follow up on a patient that he referred out. Hmmm.....
It sounds like you're saying the patient was referred from the ER to the specialist in a "transfer of care" capacity, basically turning everything over to the new doctor. If that is the case, then no a consult would not be appropriate. In the consult guidelines it states that if the new provider is completely taking over care of the patient, then the new provider should bill a new/established patient office visit as appropriate. Make sense?
A consult is a request for another doctor's opinion on treatment (whether the physician providing the consult assumes care or not). When a patient is referred from the ER there is no request, the expectation is that the doctor receiving the referral will assume care for the problem.

Documentation for a consult requires more than a "CC" to the referring provider. The documentation requirements are (the 3 Rs) 1) A request from a physician or other appropriate source, 2) Rendering of the service (with appropriate documentation), 3) Respond to the requesting provider. While many physician's will "CC" their notes to other providers treating the patient this is really for continuity of care, it doesn't make them consults.
consult documentation requirements

Does anyone have a link to the requirements? I have a PA that is refusing to put the requesting physician on the documentation and wants to see it in writing, also having trouble gettings the dates on there....I've been searching for a few days but have only found references to consults prior to 2010.

Any help or links would be most appreciated! Thank you!