Does referring to a specialist or a "Consult" counts for "additional work up" ?

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Does referring to a specialist or a "Consult" counts for "additional work up" ?

Does referring to a specialist or a "Consult" counts for "additional work up" when leveling e/m visits? and also what are some examples of "drug therapy requiring intensive monitoring from physician in the "risk" box of the auditing sheet?
 

mhstrauss

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Does referring to a specialist or a "Consult" counts for "additional work up" when leveling e/m visits? and also what are some examples of "drug therapy requiring intensive monitoring from physician in the "risk" box of the auditing sheet?
For your first question, I've never seen a black and white answer. My thoughts are, if a provider is referring a patient to a specialist, then no, I wouldn't count it as additional workup, because this provider will now no longer be handling this problem ( I work for specialists, not PCP). But if a consult, then it is expected that this provider will continue to be involved in the care for this particular problem. I hope that makes sense, I'm not quite sure how to word it to make it clear.

Second question...check with your MAC to see if they have a specific list. Here's one I see referenced often, and since I can't find one with my own MAC, I refer back to it also:

http://www.palmettogba.com/Palmetto/Providers.nsf/files/Drug_Therapy_Requiring_Intensive_Monitoring_for_Toxicity.pdf/$FIle/Drug_Therapy_Requiring_Intensive_Monitoring_for_Toxicity.pdf


HTH!
 

thomas7331

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The 1995 E&M guidelines, in the section on MDM in number of diagnosis or management options, states that 'the need to seek advice from others is another indicator of complexity of diagnostic or management problems.' Since this is not incorporated explicitly in most audit tools, I believe is does fall logically into the category of additional work-up. I usually will give additional weight to the fact that a provider is requesting a consult but agree with the post above that it's different than just referring to a specialist for treatment.
 
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