Wiki Consult vs Established

[Lwright01]

I have a question, If we have an established patient that came into the hospital for a different reason, and our doctors was consulted. Can we bill for a consult or do we have to bill as established patient?

 

[SharonCollachi]

Consult codes do not differentiate between new and established, per the definitions in the CPT book.

 

[Pathos]

I have a question, If we have an established patient that came into the hospital for a different reason, and our doctors was consulted. Can we bill for a consult or do we have to bill as established patient?

The patient type of visit (Consult/New/Established) depends on a number of factors:

1) If the visit is a consultation, then the provider should include the "Rs" when documenting a consult. AAPC has published a couple articles on this subject:

1. Remember the Three Rs for Payers Accepting Consults
2. Consultation Coding for Medicare

2) Depending on the patient's insurance carrier, Consults may not be recognized or payable and should then be cross walked where appropriate. This means for example a Medicare patient that initially came in for a Consult would now be billed as either a New or Established patient, depending on their 3 year patient status.

Hope this is helpful!

 

[Orthocoderpgu]

I agree with Pathos. Don't automatically look to the "Consultation" codes simply because your physician used that term. Study those articles about consultations and make sure that all three "R" s are met. Even then there is a 75% chance you will not be able to use the consultation code due to insurance as most no longer make payment on those codes.

 

[Lwright01]

Thanks everyone.