consult or new patient coding assistance needed

cwater

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1. If physician sees a patient who has paperwork that says “referral” or “transition of care” on it from the PCP or other referring provider, is this a consult or a new patient e/m? We have seen some of this paperwork have “referral” and “consult” on the same pages and my physician wants to bill a consult. I want to say that in the case of the "referral" if the requirements of the consult are met, he could bill a consult. In the case of "transition of care", I would bill a new patient visit.

2. Acute care clinic doctor speaks to my physician and my physician agrees/ accepts to see a patient same day-----consult or new pt? Lots of patients seem to get their primary care needs from these clinics so my physician wants to code a consult since he spoke to the referring doc. I would say that he could bill a consult as long as all the additional requirements for a consult are met.

Any insight regarding the above situations would be greatly appreciated.

Thanks,
Camille Waterhouse, CPC
 

CodingKing

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The Intent of the referral is what is important, transfer of care or opinion. It must meet the 3 R's.

With your second question. Primary care provider would never bill a consult. It just sounds like the ER doc is tired of the patient getting non emergency services in the ER and is assisting them in finding a PCP. The intent is transfer of care so its not a consult.
 

cwater

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Let me clarify the second question. My physician is a specialist and the patient was seen by the acute care clinic. The patient is using the acute care clinic as the "PCP". The acute care clinic spoke with my physician (the specialist) and we agreed to see the patient that day. My physician (spealsit) wants to bill a consult since he spoke with the acute care clinic physician who asked my physician to see the patient. Consult or New?

Thanks,
Camille
 

CodingKing

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Let me clarify the second question. My physician is a specialist and the patient was seen by the acute care clinic. The patient is using the acute care clinic as the "PCP". The acute care clinic spoke with my physician (the specialist) and we agreed to see the patient that day. My physician (spealsit) wants to bill a consult since he spoke with the acute care clinic physician who asked my physician to see the patient. Consult or New?


Thanks,
Camille


Speaking with the referring and agreeing to see the patient isn't enough to meet the 3 r's. Are they requesting an opinion on how the patient where plan is for patient to go back to the walk-in clinic to continue care? Is a written report also being provided back to the acute care provider? Patient may be inappropriately using the clinic as a PCP but usually those clinics send you off with the expectation of you following up elsewhere.
 
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