Wiki consult or new patient?

[cwater]

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]

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.