Consultation or No Consultation?

ArtDC

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Hi all,
I have a question regarding one of my docs that saw a patient for a consultation only.
The doctor spent an hour with this patient and reviewed his very convoluted medical history,
interpreted many of his outside tests (MRI, Cats, etc) for and to him, discussed multiple
treatment options with him, but no physical examination was performed.
Is this time reimbursable as a consultation or no? (I'm thinking no because of the lack of examination).
If no, is it reimbursable via any coding parameter?
As always I appreciate everyone's feedback!
All the best,
Art

PS - My understanding is that whether by another physician referral for consult; or, whether the patient self-referred,
the missing physical examination component creates a problem. If I'm on the right course with that interpretation, is
there a valid code that would cover what my doc did do with the patient?
 

kivbar16

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If your provider documented time, he/she could bill a new patient E/M without an exam. I have seen it paid this way and I do personally think it is acceptable when there is a lot of documentation reviewed and counseling given to the patient and/or family. Most payers don't pay for consults; best to go with time, when possible.
 

CodingKing

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I do want to add that if a patient self referred then it's not a consultation but just a regular old E&M. Another physician must request an opinion before its considered a consult.
 

ArtDC

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Thank you guys!
I combined both your comments and presented to my doc with the admonishment that documentation better be up to snuff and better.
Very much appreciated!
Art
 

MarcusM

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Consultation requires a referral from a provider, documentation of the actual visit and a report back to the referring provider. I recommend the doctor indicate something along the lines of: "I was asked by DR. XYZ to consult on patient, John Doe, for a chief complaint of my teeth itch..." and then note at the end of the report that the referring doctor was copied via fax #....
 
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