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Wiki consult?
- Thread starter julia9723
- Start date
RebeccaWoodward*
True Blue
B. Consultation Followed by Treatment
A physician or qualified NPP consultant may initiate diagnostic services and treatment at the initial consultation service or subsequent visit. Ongoing management, following the initial consultation service by the consultant physician, shall not be reported with consultation service codes. These services shall be reported as subsequent visits for the appropriate place of service and level of service. Payment for a consultation service shall be made regardless of treatment initiation unless a transfer of care occurs.
(Page 53)
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
Modifier 57: Decision for Surgery
An E/M examination coded with modifier 57 indicates a visit that resulted in the initial decision to perform a major surgery. It is used the day before or the day of major surgery. Surgeries that have a 90-day follow-up period are considered major surgeries. When coding modifier 57, ensure that the patient’s records clearly indicate when the initial decision to perform the surgery was made. Do not use modifier 57 with an E/M service performed on the same day as minor surgery
Modifier 25 would be attached to the E/M when performing a minor procedure (assuming they are provided on the same day).
http://www.medicarenhic.com/providers/pubs/General Surgery Guide.pdf
A physician or qualified NPP consultant may initiate diagnostic services and treatment at the initial consultation service or subsequent visit. Ongoing management, following the initial consultation service by the consultant physician, shall not be reported with consultation service codes. These services shall be reported as subsequent visits for the appropriate place of service and level of service. Payment for a consultation service shall be made regardless of treatment initiation unless a transfer of care occurs.
(Page 53)
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
Modifier 57: Decision for Surgery
An E/M examination coded with modifier 57 indicates a visit that resulted in the initial decision to perform a major surgery. It is used the day before or the day of major surgery. Surgeries that have a 90-day follow-up period are considered major surgeries. When coding modifier 57, ensure that the patient’s records clearly indicate when the initial decision to perform the surgery was made. Do not use modifier 57 with an E/M service performed on the same day as minor surgery
Modifier 25 would be attached to the E/M when performing a minor procedure (assuming they are provided on the same day).
http://www.medicarenhic.com/providers/pubs/General Surgery Guide.pdf
FTessaBartels
Guest
Referral or Request for consult?
Bess begins: If a physician refers a patient to a surgeon (emphasis added by FTB)
The "red flag" to me is "refers." If the physician knows the patient needs surgery and is sending the patient to a surgeon for the procedure, then you do NOT have a consult.
If the physician asks the surgeon for a consultation regarding X problem, and on evaluation of the patient the surgeon determines that surgery is necessary, then you have a consult. And, yes, even if the surgery is performed that very day, you can still code the consult (with -57 modifier to signify the decision for surgery).
I used to explain it to my orthopaedic team this way ... if the pediatrician sends a patient to you because the child's leg is broken and the pediatrician wants you to treat the fracture, it's not a consult. If the pediatrician asks for your opinion on how to manage a scoliosis that he has noted, it's a consult, even if you decide that the condition warrants further treatment by you (up to and including spinal fusion).
F Tessa Bartels, CPC, CEMC
Bess begins: If a physician refers a patient to a surgeon (emphasis added by FTB)
The "red flag" to me is "refers." If the physician knows the patient needs surgery and is sending the patient to a surgeon for the procedure, then you do NOT have a consult.
If the physician asks the surgeon for a consultation regarding X problem, and on evaluation of the patient the surgeon determines that surgery is necessary, then you have a consult. And, yes, even if the surgery is performed that very day, you can still code the consult (with -57 modifier to signify the decision for surgery).
I used to explain it to my orthopaedic team this way ... if the pediatrician sends a patient to you because the child's leg is broken and the pediatrician wants you to treat the fracture, it's not a consult. If the pediatrician asks for your opinion on how to manage a scoliosis that he has noted, it's a consult, even if you decide that the condition warrants further treatment by you (up to and including spinal fusion).
F Tessa Bartels, CPC, CEMC
Last edited:
RebeccaWoodward*
True Blue
Bess,
Tessa is dead on with her post. I assumed that the consult, itself, was not in question but whether or not you could charge for both. My answers are more direct whereas other coders elaborate. I can always count on Tessa to highlight on the "gray" areas. Thanks Tessa...I sure wish I could get this reputation glitch worked out. You deserve Kudos!
Tessa is dead on with her post. I assumed that the consult, itself, was not in question but whether or not you could charge for both. My answers are more direct whereas other coders elaborate. I can always count on Tessa to highlight on the "gray" areas. Thanks Tessa...I sure wish I could get this reputation glitch worked out. You deserve Kudos!