Consultation coding


Local Chapter Officer
Danville, PA
Best answers
I'm sure I know the answer to this question, but asking where to find supporting resources for the physician.
Scenerio: Physician see's a patient in-house while pt is admitted, charges and IP consultation. After pt is discharged, pt returns to that same phsycian's outpatient office... this visit would be considered an established OV because the physican seen this same patient in house, correct? This is what we have been following and we cannot find any supporting resources stating so. Any suggestions? Thanks!
That is correct, the patient is now an established patient. See the E & M guidelines in the CPT code book, that is your supporting resource.
est patient

If you refer to your E&M guidelines in the CPT book it states-

"An established patient is one who has received professional services from the physician, or another physician of the same specialty who belings to the same group practice, in the last 3 years."

It doesn't matter where the patient was seen. They received professional services from the physician so they would be established.

Hope this helps.

That is correct, you can find documentation in the E/M guidelines of the CPT book. The doctor performed a face to face service in the hospital so when the doctor sees again (within 3 years) the patient is established.