Wiki consult requested by ER Doc

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stpat

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I know that an ER Doc can request a consult in the hospital setting but we seem to get alot of new patients scheduled in the office as a consultation requested by the ER Doc. Since we are a cardiology office, I am guessing that maybe at discharge, an ER Doc might advise follow-up, say with a cardiologist, but he can't request a consult outside the hospital setting. I am hoping to get this clarified for our doctors because they think that they can bill a consultation in the office with the ER Doc as the requesting doctor. Is this stated anywhere in writing that it can't be done?
 
I. Examples That Do Not Meet the Criteria for Consultation Services

EXAMPLE 1: Standing orders in the medical record for consultations.

EXAMPLE 2: No order for a consultation.

EXAMPLE 3: No written report of a consultation.

EXAMPLE 4: The emergency room physician treats the patient for a sprained ankle. The patient is discharged and instructed to visit the orthopedic clinic for follow-up. The physician in the orthopedic clinic shall not report a consultation service because advice or opinion is not required by the emergency room physician. The orthopedic physician shall report the appropriate office or other outpatient visit code.

Different specialty but concept still applies. (30.6.10)

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
 
I just had to research to find something in writing on this for my physician group also. Medicare Claims Processing Manual, Chapter 12, Section 30.6.10B states:

"Transfer of care - A transfer of care occurs when a physician or qualified NPP requests that another physician or qualified NPP take over the responsibility for managing the patients' complete care for the condition and does not expect to continue treating or caring for the patient for that condition. When this transfer is arranged, the requesting physician or qualified NPP is not asking for an opinion or advice to personally treat this patient and is not expecting to continue treating the patient for the condition. In a transfer of care the receiving physician or qualified NPP would report the appropriate new or established patient visit code according to the place of service and level of service performed and shall not report a consultation service".

Kay Ruhe, CPC, CCS-P
 
Normally, the intent of the ER physician is not to ask for the advice or opinion of the consultant. He/she may call in a specialist, but normally this is a transfer of care. Which is not a consultation. When the ER physician has exhausted their efforts, they pass the buck to the next physician. When a patient is discharged from the ER, the ER physician makes recommendations as to who to follow up with, such as a cardiologist, but the ER physician isn't playing a role managing the patient care after discharge. Therefore, in your case, you would use new patient codes.

Hope that helps
 
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