Data level for sending out for consult

lhoot

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Hello,
If a physician sends a patient for a consult (not a referral), does this count towards data like ordering a lab or imaging would?

Thanks in advance for any advice,
Laura
 

thomas7331

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No, there isn't an entry in the data category for requesting a consult. The need for a consult is already incorporated into the E/M because it can be considered 'additional work-up planned', so can affect the points assigned in the diagnoses and treatment options category.
 

lhoot

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My apologies in leaving out the type of visit my question is for. This is for an office visit. Additional work-up planned isn't part of the new guidelines, so I'm stumped.
 

thomas7331

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My apologies in leaving out the type of visit my question is for. This is for an office visit. Additional work-up planned isn't part of the new guidelines, so I'm stumped.
I don't think this is explicitly addressed in the new guidelines. I would still consider a factor in the first section because it's an indicator of the complexity of the problem(s) addressed if the provider must request a specialist evaluation. However, I think it would be reasonable to consider it as a data point instead since it's similar to requesting a test or an outside record for review. In other words, I think it's clearly a factor that affects MDM, but how you're going to count it is going to be a coding judgment call.
 
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