Wiki Consults

[01085585]

I have a question:

I know thatif our general surgeon sees a patient ( other than Medicare) as a consult referred by an outside provider that he has to state that he sent t "thank you" letter to the referring doctor and send records, etc... But if one of our doctors inside the clinic refers a patient do we have to document that a letter and records were sent since we all share the records, the inside referring doctor as access to the chart at anytime.
Thank you,
Ashley Little, CPC

 

[btadlock1]

I have a question:

I know thatif our general surgeon sees a patient ( other than Medicare) as a consult referred by an outside provider that he has to state that he sent t "thank you" letter to the referring doctor and send records, etc... But if one of our doctors inside the clinic refers a patient do we have to document that a letter and records were sent since we all share the records, the inside referring doctor as access to the chart at anytime.
Thank you,
Ashley Little, CPC

I'm not sure I get what you're asking, but I'll try to answer your question:
1. It's not exactly a 'thank you' letter - to bill a "consult" code, you have to have a request for a doctor's opinion, from a qualified source (eg, doctor, PA, etc.), then the consulting doctor sees the patient, and makes recommendations (either on the patient's diagnosis or treatment plan), which he sends back to the requesting provider, in writing. He's not saying "thanks", as much as "here's what I think".
2. A referral is different - it's when a patient is sent to another provider, with the intent of having that provider assume responsibility, for managing a particular condition. You don't bill consult codes for referrals - just regular E/M's, depending on the place of service, as usual.
3. Unless the providers are from different specialties within your clinic (eg, Family practice & IM, or GI, etc.), it's not really a referral - you 'refer' patients to someone with expertise in a specific area, which is why the vast majority of referrals, are to specialists.
4. Assuming the doctors are from different specialties, you still want to be careful about making referrals to someone else inside of your practice, to avoid violating the STARK or Anti-Kickback Statutes (see this page: http://oig.hhs.gov/compliance/safe-harbor-regulations/index.asp and look at the info on the Safe Harbors and Physician Self-referral law, in particular - I recommend reading every publication that the OIG has to offer; they're very informative, and will give you invaluable info on compliance)

And finally, if you share charts, for either for a consult or referral, the request can be documented once in the record. Also, the written response required for consults can be documented in a shared chart, but the requesting physician should confirm that they read it, in their own entries. There's no need to mail a separate copy...hope that helps!

 

[MnTwins29]

Thank you "note"

While I usually see this in hospital documentation, I have often seen at the end of the report that the physician providing the requested service will thank Dr. A for allowing him to care for the patient. This documentation has passed muster as proof that there was a request from another physician. Also, again in hospital documenation, if the admitting or primary physician is the one who requested the consult, I have seen that when that physician writes his or her notes for the next day, they will notate that they reviewed Dr. B's note.

 

[hunters]

Consult proof of reply using ehr

You're using a EHR but the requesting physician is not using the same EHR (outside physician) - however, the EHR allows you to electronically fax a copy of the office note back to the requesting physician - but once you have electronically faxed the note there is still nothing showing as proof that the record was indeed actually successfully faxed. So currently our nursing staff are simply appending the office note to state: NOTE FAXED TO DR. X. Is this considered sufficient "proof of reply" back to the requesting physician in order to bill a CONSULT? Other references and CPC's are telling me "NO", that either a letter from the physician needs to be in the patients chart and/or an actual visual Fax Confirmation Page needs to be in the patients chart because anyone can just append a note to say that something was done -- it doesn't mean it actually WAS done. Any help on this issue would be greatly appreciated !!