maine4me
Guru
I apologize for yet another question regarding consultations, however some questions regarding the request portion of the consultation requirements have been asked, on question one I am not sure of the answer, and question two my response is being disputed by a member of administration. Thank you in advance for helping me once again.
1. We have a breast surgeon who often will receive calls from the radiologists in our women's diagnostic center, stating that the patient had abnormal findings on the imaging and needs to see a surgeon. As the discussion went on, it seems that all patients with abnormal breast imaging are sent to the surgeons office as part of the process. So the question is, does the "referral" from the radiologists satisfy the request requirement in order to bill a consult? My gut feeling is that this would not meet the guidelines, since we would not be sending the report back to the radiologists, but rather to the patient's gynecologist or primary care physician.
2. There has been much discussion amongst our practice managers and administration regarding the fact with the dawn of EMR's and more online processes that a formal request is rarely received. I advised that the request for consultation does not have to be on paper, but can also be a verbal request, as long as both the consulting physician and the requesting physician document this in the patients chart. The question keeps coming up that the insurance referral should be considered a request for consultation. I completely disagree with this view, since just because an insurance referral is issued, this does not mean a consult request has been made. There has been some talk about if a patient is sent to the specialist office for a visit, that we create our own consult request form to send to the PCP or other referring physician to have them sign and indicate the desire for consultation and the opinion of the specialist based on his or her expertise. I guess I am looking for guidance from the group about whether the insurance referral can double as the request, and if not how other offices handle this type of situation?
1. We have a breast surgeon who often will receive calls from the radiologists in our women's diagnostic center, stating that the patient had abnormal findings on the imaging and needs to see a surgeon. As the discussion went on, it seems that all patients with abnormal breast imaging are sent to the surgeons office as part of the process. So the question is, does the "referral" from the radiologists satisfy the request requirement in order to bill a consult? My gut feeling is that this would not meet the guidelines, since we would not be sending the report back to the radiologists, but rather to the patient's gynecologist or primary care physician.
2. There has been much discussion amongst our practice managers and administration regarding the fact with the dawn of EMR's and more online processes that a formal request is rarely received. I advised that the request for consultation does not have to be on paper, but can also be a verbal request, as long as both the consulting physician and the requesting physician document this in the patients chart. The question keeps coming up that the insurance referral should be considered a request for consultation. I completely disagree with this view, since just because an insurance referral is issued, this does not mean a consult request has been made. There has been some talk about if a patient is sent to the specialist office for a visit, that we create our own consult request form to send to the PCP or other referring physician to have them sign and indicate the desire for consultation and the opinion of the specialist based on his or her expertise. I guess I am looking for guidance from the group about whether the insurance referral can double as the request, and if not how other offices handle this type of situation?