DE,
I completely understand your dilemma. Here was my scenerio for the week...
Patient presents to ER for fracture/sprain. ER physician renders treatment and requests that the patient
follow up with our orthopedic provider (in office). When the patient arrived to the office, the visit was charged as a consult. This is
clearly not a consult. Not only was the ER physician NOT asking for an opinion but this was a transfer of care. Guidelines, regulations, emails..... were provided in order to educate everyone. Even with Medicare Chapter 12 in hand, it was still an arm wrestling match.
Examples That Do Not Meet the Criteria for Consultation Services
EXAMPLE 1: Standing orders in the medical record for consultations.
EXAMPLE 2: No order for a consultation.
EXAMPLE 3: No written report of a consultation.
EXAMPLE 4: The emergency room physician treats the patient for a sprained ankle. The patient is discharged and instructed to visit the orthopedic clinic for follow-up. The physician in the orthopedic clinic shall not report a consultation service because advice or opinion is not required by the emergency room physician. The orthopedic physician shall report the appropriate office or other outpatient visit code
Transfer of Care
A transfer of care occurs when a physician or qualified NPP requests that another physician or qualified NPP take over the responsibility for managing the patients’ complete care for the condition and
does not expect to continue treating or caring for the patient for that condition.
When this transfer is arranged, the
requesting physician or qualified NPP is
not asking for an opinion or advice to personally treat this patient and is not expecting to continue treating the patient for the condition. The receiving physician or qualified NPP shall document this transfer of the patient’s care, to his/her service, in the patient’s medical record or plan of care.
In a transfer of care the receiving physician or qualified NPP would report the appropriate new or established patient visit code according to the place of service and level of service performed and shall not report a consultation service.
Good luck...This is never an easy task.