Wiki Consult - Help

[KoBee]

Having trouble trying to figure out if i could use consultation codes 99241-45 based on the 3 Rs. Can someone advice by looking at the report below.



I'm having trouble as to what am i looking for in a report to support a consult. I don't see anywhere that the consultant provider is reporting back to primary besides a report. Qhat words exactly should a consultant be documenting to support the consult?

• A request for a consultation, along with the need for a consultation, must be documented by the consultant in the patient's medical record and included in the patient's medical record of the requesting practitioner.
  • There is a referral in placed, provider is also documenting in his report who referred the patient.
• An opinion is rendered by the consulting practitioner. This opinion, along with any other service provided, is documented in the patient's health record
• A written report of the consultant's findings and opinion or recommendation is communicated back to the requesting practitioner.

There is a report from Podiatrist with HPI/EXAM/MDM, does this count as an opinion & written report?




Podiatry: XXXXX, DPM
Reason: Ingrown toenail
Dx Ingrown Toenail
Referred by XXXXX, MD

Progress Notes
XXXXX, DPM (Physician) • • Podiatry


SUBJECTIVE:
The patient presents with the chief complaint of a painful, ingrown toenail on the left big toe, outside border. The patient states the symptoms have been present for 3 months and are getting progressively worse. The patient states there has been some drainage and bleeding. The patient states they have been treated with antibiotics, started today. The patient states they have not had a previous occurrence on this nail border.

REVIEW OF SYSTEMS:
Physical Examination: General appearance - alert, well appearing, and in no distress, oriented to person, place, and time and normal weight.

PHYSICAL EXAMINATION:
Height is 5'7", weight is 180 lbs, shoe size is 9.5. Palpable DP and PT pulses noted, bilateral. Protective sensation is intact, bilateral. Muscle strength is 5/5 as tested, bilateral.

There is diffuse tenderness, proud flesh, erythema, and edema noted on the left, lateral, hallux nail(s) border(s). There is evidence of purulent drainage.

ASSESSMENT:
No diagnosis found.

PLAN:
During my encounter with the patient today I was able to document the patient’s current medications to the best of my knowledge and ability. Patient's allergies, past medical, surgical, social and family histories were reviewed and updated as appropriate.

Under sterile prep and local anesthesia consisting of ethyl chloride, the affected nail border(s) was avulsed and the paronychia was debrided. Sterile antibiotic dressing was applied. Complete post-op instructions given. The patient is to return to the clinic if any symptoms return or persist.


Instructions
Return in about 4 months (around 10/25/2021), or if symptoms worsen or fail to improve, for possible matricectomy.
Soak the toe for 10-15 minutes daily in warm water with antibacterial soap, only a few drops of soap per quart of water. Do this for 2-4 days. Some drainage is normal.

Dry the wound thoroughly and apply triple antibiotic ointment and a bandage for 1-2 weeks.

Continue to apply a bandage to the toe for about 3-4 weeks, longer if necessary. There should be no pain, redness, or drainage by this point.

 

[jkyles]

Hi there, a referral isn't automatically a consult. It can be a sign that the the referring provider wanted a consult, but you need to have a clear request from the referring doctor, such as "Hi Bob, I'm sending Fred Fredson to you for a consult on his ingrown toenail." In addition, if the DPM had sent their written opinion/recommendations back to the referring doctor you'd have some record of that information being transmitted. The note alone isn't enough.

However, the Instructions make it clear that this was a referral and the podiatrist has assumed care for this condition, rather than a consult.

(Also - please make sure the payer covers consults. Most don't these days.)

 

[KoBee]

Hi there, a referral isn't automatically a consult. It can be a sign that the the referring provider wanted a consult, but you need to have a clear request from the referring doctor, such as "Hi Bob, I'm sending Fred Fredson to you for a consult on his ingrown toenail." In addition, if the DPM had sent their written opinion/recommendations back to the referring doctor you'd have some record of that information being transmitted. The note alone isn't enough.

However, the Instructions make it clear that this was a referral and the podiatrist has assumed care for this condition, rather than a consult.

(Also - please make sure the payer covers consults. Most don't these days.)

Thank you - this was great feedback. Also just a bit confused on what an opinion back to the referring provider should be from the consulting provider? I do see many of our providers don't really render an opinion back at all, just see the patient continuing care with consulting provider for the condition they were referred for.

 

[jkyles]

Hi there, glad that helped. If they aren't getting an opinion back to the referring doctor you would not bill a consult, even if they intended to do a consult. Here is an example from CPT Assistant, 8/2001

Primary care physician (PCP) has been monitoring and treating a 78-year-old established patient for known congestive heart disease (CHD) over a period of time. Based upon recent findings, the PCP requests a cardiology consultation. The intent is to obtain an opinion and advice relevant to the status of the patient's CHD, current treatment, revised therapy, new therapy, recommended monitoring, and any other clinical needs. The consulting cardiologist evaluates the patient and makes recommendations for management to the PCP. The PCP accepts the recommendations and implements the plan of care.

Fourteen months later, the PCP again requests a consultation from the same cardiologist for the same condition. The consulting cardiologist evaluates the patient and makes recommendations for management to the PCP. The PCP accepts the recommendations and implements the updated plan of care.