Wiki consult/e&m visit same day


Richfield, PA
Best answers
I work for a multi physician family practice. We have a provider who is billing a consult (to clear a patient for a screening colonoscopy) and an E&M visit on the same date for follow up of chronic problems. Several of the physicians in our practice do colonoscopies and we do have standing orders for patients over the age of 50 to have a screening colonoscopy. It is my opinion that the documentation does not qualify for billing a consult. The patient was not referred here for a consult. The consult, according to the physician, is based on the fact that she is clearing the patient for a screening colonoscopy for another physician in the practice to perform. All the physicians bill under the same tax ID# and have the same taxonomy codes. The physician disagrees with this. Need some advice as to whether I am totally off base with this. If not, need some documentation to prove it. Appreciate any help with this.
You cannot bill a consult for a screening colonoscopy. Even if the patient is referred to you for this, once the patient is determined to meet the criteria for a screening then the medical necessity has been determined and it cannot be charges again. If the patient presents for a wellness visit then it should be billed as the preventive E&M and done. Even to discuss the chronic issues is part of a preventive visit on a yearly basis. You are correct that a consult requires a request from a qualified provider ( look in the CPT book under the consult heading), a patient self referral is coded as an office visit , but in this case it looks like a preventive.