Consult coding

avhadvidya@gmail.com

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HELLO ,

Can anyone one explain me when to consider "consult" and "office visit"?

what if in medical records below line is mentioned:

"Patient presents here for consultation as referred by Dr.XYZ"

will be consider it as "consult" or " office visit"?
 

bdcoyne8

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Local Chapter Officer
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Idaho Falls
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In order to bill for a consultation - it's best to remember the 3 R's; Referring/Requesting Provider, Reason for the consult, Response/Report back to the requesting provider. As long as those three are documented, you can bill for a consultation.

It would be better if the provider stated "This patient presents for a consultation requested by Dr. A for abdominal pain" After the provider does their note (history, exam, MDM) there should be something that indicates that a copy of the report was sent to Dr. A. If the providers share the same EHR software (a multi-specialty practice), they don't have to specifically state that as the requesting provider has access to that patient's chart as they are in the same group practice. But if it is an outside provider, it must be documented clearly that the consulting provider sent a copy or discussed the results with the requesting provider.

The best way to understand a consult vs office visit; Is the referring provider sending the patient to another provider to be treated or are they sending the patient to another provider and asking that provider to see what is going on with the patient but expect a response/opinion back?

1. A patient with a necrotic wound would most likely be sent by the PCP to a wound care specialists or infectious disease to be treated as the PCP doesn't do those type of things. (this is not a consult)
2. A patient comes to their PCP and has abdominal pain and the PCP doesn't know why, they would most likely send them to a GI specialist for a consult or an opinion to see if they can help the patient but the PCP would like to know what is happening with the patient so they can participate in the patients care. (this is a consult)

Does this help at all?
 

AdamShoop

Networker
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68
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In order to bill for a consultation - it's best to remember the 3 R's; Referring/Requesting Provider, Reason for the consult, Response/Report back to the requesting provider. As long as those three are documented, you can bill for a consultation.

It would be better if the provider stated "This patient presents for a consultation requested by Dr. A for abdominal pain" After the provider does their note (history, exam, MDM) there should be something that indicates that a copy of the report was sent to Dr. A. If the providers share the same EHR software (a multi-specialty practice), they don't have to specifically state that as the requesting provider has access to that patient's chart as they are in the same group practice. But if it is an outside provider, it must be documented clearly that the consulting provider sent a copy or discussed the results with the requesting provider.

The best way to understand a consult vs office visit; Is the referring provider sending the patient to another provider to be treated or are they sending the patient to another provider and asking that provider to see what is going on with the patient but expect a response/opinion back?

1. A patient with a necrotic wound would most likely be sent by the PCP to a wound care specialists or infectious disease to be treated as the PCP doesn't do those type of things. (this is not a consult)
2. A patient comes to their PCP and has abdominal pain and the PCP doesn't know why, they would most likely send them to a GI specialist for a consult or an opinion to see if they can help the patient but the PCP would like to know what is happening with the patient so they can participate in the patients care. (this is a consult)

Does this help at all?
Great answer! I've never heard of the 3 R's, so i'll have to commit that to memory :) Thanks.
 

avhadvidya@gmail.com

Contributor
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Location
Mumbai, Maharashtra
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In order to bill for a consultation - it's best to remember the 3 R's; Referring/Requesting Provider, Reason for the consult, Response/Report back to the requesting provider. As long as those three are documented, you can bill for a consultation.

It would be better if the provider stated "This patient presents for a consultation requested by Dr. A for abdominal pain" After the provider does their note (history, exam, MDM) there should be something that indicates that a copy of the report was sent to Dr. A. If the providers share the same EHR software (a multi-specialty practice), they don't have to specifically state that as the requesting provider has access to that patient's chart as they are in the same group practice. But if it is an outside provider, it must be documented clearly that the consulting provider sent a copy or discussed the results with the requesting provider.

The best way to understand a consult vs office visit; Is the referring provider sending the patient to another provider to be treated or are they sending the patient to another provider and asking that provider to see what is going on with the patient but expect a response/opinion back?

1. A patient with a necrotic wound would most likely be sent by the PCP to a wound care specialists or infectious disease to be treated as the PCP doesn't do those type of things. (this is not a consult)
2. A patient comes to their PCP and has abdominal pain and the PCP doesn't know why, they would most likely send them to a GI specialist for a consult or an opinion to see if they can help the patient but the PCP would like to know what is happening with the patient so they can participate in the patients care. (this is a consult)

Does this help at all?
yes off course. thanks a lot
 

avhadvidya@gmail.com

Contributor
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Mumbai, Maharashtra
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Ohk i understand but my Client is concerned about patient which are not having any referring physicians or are self referrals how they will be handled for consult.please help as we need to get back them on it.
 

twizzle

True Blue
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Sarasota FL
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Ohk i understand but my Client is concerned about patient which are not having any referring physicians or are self referrals how they will be handled for consult.please help as we need to get back them on it.
If there is no referring provider as bdcoyne8 said, it is not a consult. Also, if the patient refers themselves, it is not a consult.
Does this answer your question?
 
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