consults and comanagement

emetayer

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If an ophthalmologist (MD) has an arrangement with an optometrist (OD) to comanage cataract pts, can the MD bill a consult code for the initial evaluation (assuming that there was a formal written request from the OD and a report back to the OD and that all 3 levels of HEM are met)?

Here's how I think of it - you are transferring care back to the OD, therefore the initial evaluation should be not be billed as a consult.

Input anyone?
 
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What's the intent of the request

If the OD is requesting a consultation for advice on management of the patient's cataracts then the Ophthalmologist would correctly code a consult and return the patient to the OD, who will (presumably) follow the Ophthalmologist's recommendations on treatment.

If the OD is sending the patient to the Ophthalmologist to be treated for cataracts and the patient is going back to the OD just for refractive services, then you have a new (or established) patient for the Ophthalmologist because the OD has simply referred the patient to the MD for treatement.

A lot hinges on your opening statement that they have an "arrangement to comanage cataract patients." It seems like a "I'll take care of this, you take care of that" kind of scenario, which would NOT be a consultation, but a referral. But I'm not certain that I'm interpreting this accurately.

F Tessa Bartels, CPC, CEMC
 
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