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Consultation or Office Visit? - completion of a consultation

prentice525

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CPT says that if after the completion of a consultation, the consultant assumes responsibility for management of the patient, the appropriate E/M service for the site of service should be reported.
It goes on to say that in the office setting, the provider would use the appropriate office consultation code and then the established patient office service code.

Does this mean that in the physician office, after the doctor completes the consultation, if he/she assumes responsiblity of care, an office visit E/M can be billed in addition to the consultation code? Both on the same day or wouldn't there be too much overlap in the key components? Am I reading that correctly? Thanks!
 

mhstrauss

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CPT says that if after the completion of a consultation, the consultant assumes responsibility for management of the patient, the appropriate E/M service for the site of service should be reported.
It goes on to say that in the office setting, the provider would use the appropriate office consultation code and then the established patient office service code.

Does this mean that in the physician office, after the doctor completes the consultation, if he/she assumes responsiblity of care, an office visit E/M can be billed in addition to the consultation code? Both on the same day or wouldn't there be too much overlap in the key components? Am I reading that correctly? Thanks!
You are correct in thinking that there would be in overlap in the key components if you billed both the consult and established codes for the initial visit. Only one should be used.
Ex:

Doc A sends patient to ortho (doc B) for eval of knee pain. Doc B sees patient for first time. If Doc B takes over treatment for the knee pain, a consult should not be billed for this initial visit. Instead a new patient visit should be used (provided that the patient has not seen Doc B in the last 3 years). And any followup visits would be billed as established patient codes, of course.

However, if Doc B sees patient for the initial visit, and defers care back to Doc A, sends Doc A a report with his H&P, exam, recommendations, etc, then Doc B can charge a consult, since he is not assuming care for the knee pain.

Other scenario: Doc B see patient for initial visit, but cannot make decision on treatment or other recommendations until x-rays (or testing) is completed. Since he won't know til later whether or not he will assume care for this condition, he is allowed to charge a consult.

Hope this makes sense! :)
 
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prentice525

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Yes! Makes perfect sense. More sense than the CPT wording makes. Thank you for the prompt reply! :)
 

pandi1024

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A physician can take over the care of the patient and still bill a consult for the initial visit as long as the elements of a consult are met. However, there are not consult follow up codes, so future visits would be billed with the appropriate E&M.
 
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