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Wiki Documentation for Consults

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krssy70

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As you all must know, Consults no longer can be billed to Medicare.:mad: We are an Oncology group that bills alot of consults. I am receiving alot of questions from the physicians about how they should dictate their note. On the documentation side, should they continue to dictate them as consults, or dictate that the patient is a new patient, and not give the referring physician info. :confused:I'm just looking for some input to pass on to the physicians.

Thank you,
Kristen Richard, CPC
 
If you look in this months issue of Coding Edge there is an article on consultations and a cutout with information presented at the November AMA symposium.
Anyway this states that "CMS does away not only with the consultation codes, but with all consultation requirements as outlined in CMS policy. However it goes on to say that certain as of yet undetermined documentation requirements may be necessary to demonstrate medical necessity for E&M services billed in place of consultations - especiall if two physicians are seeing the same patient for the same dx. So the report could be the way to show the service is distinct.
I felt this was right on the money so I would encourage the documentation to stay the same in the event you may need that for an appeal.
 
I was thinking the same thing. I feel that the documentation should not change. Even if Medicare were to audit those claims, the documentation requirements are the same from consults to new patients. So all the same requirements are needed for each visit. We will also continue to follow up with the referring physicians even though we cannot bill for the consult. patient care is #1. I will also check out that article.

Thank you for your input,
 
Documentation requirements

I listened in on a HcPro audio conference a couple weeks ago, and I asked this same question. My thoughts are why are they doing away with the consult codes and taking away reimbursement for the specialties that ALL do consults, but the Physicians are still required to do the work and document for a consult?

The answer is YES, the physicians still need to meet the documentation requirements for the consults for medical necessity purposes. I have been telling our physicians DO NOT change the way you would document for a consult, because this is only Medicare's rule as of right now. Therefore, the other third party payors are going to require the documentation of a consult.
 
More questions on documentation of consults

I was also wondering about the criteria for an appropriate consult. Some of my physicians don't necessarily document that the visit is due to a request from the referring provider. So I was wondering, if the physician documents that a cc was sent to the ref provider, and we have the referral letter on file from the referring providers office requesting the visit, and we also have the appointment scheduled as a consult and have entered all the referring provider info in the appt scheduler, can we still bill a consult even though the provider did not specifically state at the heading of the note that it is a consult and who the referring provider is?

Thanks in advance
Kristen :)
 
3 R's

I do not mean to be picking on you, Kristen, but this is exactly why Medicare has decided to stop honoring the consultation codes.

Referrals are a requirement of managed care (HMOs mostly).

Requests for consultation are a very specific thing. One doctor is asking another doctor for advice on opinion on the treatment/management of a problem. The intent is that the consulting physician will report findings and recommendations for treatment to the requesting physician who will either take the consultant's advice or not.

Just because you have a "referral" on file does not mean you have a request for a consultation. And, frankly, just because the "consultant" has documented a request from Doctor PCP doesn't mean that this wasn't a transfer of care (e.g. patient referred FOR a colonoscopy).

If you physicians are legitimately being asked for a consultation, then their documentation MUST include the fact that they have been asked to consult on X problem by Y doctor, and they must provide a copy of their findings and recommendation to the requesting doctor. If you do not have ALL these requirements, you do not have a consultation.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
well said Tessa, I have nothing to add but i would love to use a couple of your statements in my presentation since you laid it out so well.
 
Well thank you for you input. You don't have to apologize, I posted the question because the question was addressed to me, and I wasn't sure. I don't want to answer a question that is asked to me without knowing for sure. This forum is about throwing questions out there to see what responses you get. Doesn't necessarily mean that you dont know what your talking about. Its just all about posting a question to see what other coders are doing. So please don't apologize and look at it like you are picking on me. Your just helping me/and others understand whatever the situation may be and making it a little clearer. And thank you for doing that. It helped alot.
 
3 R's

F Tessa,

I was re-reading your post regarding the 3 R's. Can you elaborate on that posting. If you could please give the detail on the 3 R's rule, I would appreciate it. My confusion is with the referral/request.

Thank you
Kristen :)
 
Not sure how else to explain

Kristen,
I'm not sure I know how else to explain the issue. Tell me what is confusing you and I'll try to clear it up.

F Tessa Bartels, CPC, CEMC
 
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