"OMG" Need help!
I work for a multi speciality orthopedic group and I am having a problem with when I am able to charge a consult vs a follow up when our physicians are referring with in the group.
Patient was scheduled to see one of our spine specialists for the back (first visit ever to our clinic). When the patient was being seen by the doctor, he told the physician that he has no problems with his back his main complaint is of bilateral knee pain. Our physician went ahead and assesed the patient for his knees because he was not going to send the patient away without any type of care. The spine physician came to the conclusion that this problem with the knees was out of his scope of practice and thus referred to one of our joint (knee) specialists for a consult. The patients medical group is stating that it is not a consult it would be a follow up visit since the patient has already been assesed for the same problem by the other physican. But I am following the Medicare guidelines for 2006 and it states:
[I]"Medicare may pay for a consultation if one physician or qualified NPP in a group practive requests a consultation from another physician in the same group practice when the consulting physician or qualified NPP has expertise in a specific medical area beyond the requesting professional's knowledge. A consultation service cannot be reported on every patient as a routine practive between physicians and qualified Npps within a group practice setting."[/I]
I had also consulted one of my co-workers who is also a CPC and she said that we were not able to charge a consult that it would be a follow up visit. But I am just following what the Medicare 2006 guidelines state and I had also found an article from the American College of Physicians that also states the same thing that Medicare states. Can someone help me out in understanding how to deal with this situation?
Also, if I have a patient that comes into see one of our physicans for a problem and then the physician then wants to refer to one of our other physicans for the same problem because it is out of his scope of practice how would this be coded? I just want to make sure that I am coding this correctly for future as well. Any and all responses would be helpful and if anyone has any articles, websites anything that shows the guidelines and the correct way of coding consults for referring within the same group it would be very helpful. Thank you
I work for a multi speciality orthopedic group and I am having a problem with when I am able to charge a consult vs a follow up when our physicians are referring with in the group.
Patient was scheduled to see one of our spine specialists for the back (first visit ever to our clinic). When the patient was being seen by the doctor, he told the physician that he has no problems with his back his main complaint is of bilateral knee pain. Our physician went ahead and assesed the patient for his knees because he was not going to send the patient away without any type of care. The spine physician came to the conclusion that this problem with the knees was out of his scope of practice and thus referred to one of our joint (knee) specialists for a consult. The patients medical group is stating that it is not a consult it would be a follow up visit since the patient has already been assesed for the same problem by the other physican. But I am following the Medicare guidelines for 2006 and it states:
[I]"Medicare may pay for a consultation if one physician or qualified NPP in a group practive requests a consultation from another physician in the same group practice when the consulting physician or qualified NPP has expertise in a specific medical area beyond the requesting professional's knowledge. A consultation service cannot be reported on every patient as a routine practive between physicians and qualified Npps within a group practice setting."[/I]
I had also consulted one of my co-workers who is also a CPC and she said that we were not able to charge a consult that it would be a follow up visit. But I am just following what the Medicare 2006 guidelines state and I had also found an article from the American College of Physicians that also states the same thing that Medicare states. Can someone help me out in understanding how to deal with this situation?
Also, if I have a patient that comes into see one of our physicans for a problem and then the physician then wants to refer to one of our other physicans for the same problem because it is out of his scope of practice how would this be coded? I just want to make sure that I am coding this correctly for future as well. Any and all responses would be helpful and if anyone has any articles, websites anything that shows the guidelines and the correct way of coding consults for referring within the same group it would be very helpful. Thank you