Wiki Consultation for " screening colonoscopy"

[mikesyzf]

Curious as to your opinion of a "Consultation".

The assumption is that the HPI, Exam are adequate with the exception of the following wording...:


Referring physician "requests a consultation for: screening Consultation."

HPI starts out with "Pt. presents for evaluation"....

"Impression: Female presents for a screening colonoscopy"

"Plan: Colonoscopy.... pt. elects to proceed."

My lead coder says it is ok to bill as a Consult. I say it is not since the pt. doesn't have a complaint or problem...

 

[mitchellde]

I do not see that the 3 necessary element of a consult have been documented. You must a Request, to Render back to the referring provider necessary information and write a Report back to the referring provider findings that they can use to better assess the patient.
Request
Render
Report
I only see the element of request in what you have provided so no consult. Medicare will tell you no E&M can be billed for a pre screening colonoscopy visit.

 

[mikesyzf]

Perhaps I should have stated that the documentation meets the requirements for a Consultation with the exception of the Referring Physician's reason for the consult being "Screening Colonoscopy", and the Consulting Physician's "Impression: Female presents for a screening colonoscopy" and plan being : "Plan: Colonoscopy.... pt. elects to proceed."

 

[hmbizsol70]

Medical Necessity

was there a medical necessity?

 

[mitchellde]

The problem is the request does not show that the patient is being sent for a consult to request information regarding some unknown problem that the requesting provider is unable to identify or solve. it is more of a referral to perform a screening procedure because the patient meets the criteria.

 

[mikesyzf]

That is how I saw it. The only "medical necessity" listed was "Screening Colonoscopy". I don't know how it could be considered a valid consultation... !