Wiki Consults VS Referral

[medicalsec]

I have always used the same rules for all insurance companies regarding billing for consultations. We are general surgeons, and I do not bill a consult unless I have something in writing from the referring doctor that asks for a consultation. Our doctors are insisting that I bill consultations since they are not Medicare patients. I was wondering if most follow having a written request in the chart to substantiate the code, or they just chance that the request will be in writing in the chart notes from the referring doctor.

Thanks,

Dee

 

[kimberliterpstra]

I am in a general surgery practice as well. It is our policy to only a bill a consult if there is something in writing from the referring provider; either a letter requesting the consult or a referral form with the referring provider's signature requesting the consult. Also remember, in order to bill a consult, your surgeon must communicate back to the referring provider and you cannot assume care for the condition. If there is no communication back to the referring provider and/or you assume care, it's a new patient visit and not a consult. I have one surgeon who wants to bill EVERY new patient as a consult; I tell him it's my job to protect him and if it meets the criteria, I bill it as a consult. Otherwise, it's a new patient visit.

 

[TjH111964]

Consultation-3 R's

In order to bill for a consultation, remember the 3 R's:

1.Request- written or verbal request for consult documented
2. Rendering- consultant's opinion documented
3.Report - written report to the requesting physician

 

[dclark7]

Check with your insurance carriers to find out if they have any reimbursement policies. I know Anthem Blue Cross of CT has a policy regarding consults and the required documentation. Not all do, but if you can find them they're very useful for teaching providers the requirements.