Wiki E/M order or considered referral????

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Karalea88

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One of my providers came to me with this question...... He is a PCP and wants patient to have routine Colonoscopy. He is considering the colonoscopy as an order instead of a referral. If he orders patient to have colonoscopy by an external provider can he still count test as an order??? I personally think it would only be consider as a referral since the GI or external provider will initially order test and patient will need to see GI/external provider before colonoscopy is performed. Any feedback is appreciated.
 
Karalea88 said:
One of my providers came to me with this question...... He is a PCP and wants patient to have routine Colonoscopy. He is considering the colonoscopy as an order instead of a referral. If he orders patient to have colonoscopy by an external provider can he still count test as an order??? I personally think it would only be consider as a referral since the GI or external provider will initially order test and patient will need to see GI/external provider before colonoscopy is performed. Any feedback is appreciated.
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When you say 'routine colonoscopy' do you mean a screening colonoscopy? If so, I would not count this toward MDM - that it a preventive service. Referrals for treatment or tests ordered that are counted toward MDM of an E/M service are those that involve the diagnosis and treatment of an illness or injury, not routine preventive services.

If the patient is being considered for a diagnostic colonoscopy to evaluate a particular symptom or problem that the patient has, it doesn't matter if the physician is calling it an 'order' or a 'referral' - it is still counted this toward the MDM in the risk section as a diagnostic procedure, not under the data section - a colonoscopy is a procedure, not a test.
 
SharonCollachi said:
Are you sure the GI will see the patient first? Around here, they don't. They just do colonoscopy based on pcp order. The first time you meet the doctor is in pre-op
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Depends on the GI provider. One provider schedules procedure without needing the patient to come into clinic and the other provider brings the patient in for a visit and then schedules the procedure.
 
thomas7331 said:
When you say 'routine colonoscopy' do you mean a screening colonoscopy? If so, I would not count this toward MDM - that it a preventive service. Referrals for treatment or tests ordered that are counted toward MDM of an E/M service are those that involve the diagnosis and treatment of an illness or injury, not routine preventive services.

If the patient is being considered for a diagnostic colonoscopy to evaluate a particular symptom or problem that the patient has, it doesn't matter if the physician is calling it an 'order' or a 'referral' - it is still counted this toward the MDM in the risk section as a diagnostic procedure, not under the data section - a colonoscopy is a procedure, not a test.
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Hi Thomas- I've seen this similar statement but don't recall where, do you happen to have a source document- "Referrals for treatment or tests ordered that are counted toward MDM of an E/M service are those that involve the diagnosis and treatment of an illness or injury, not routine preventive services."
So if a patient presented to their PCP for say an ankle sprain, and the provider placed orders this visit for screening labs (asymptomatic, no known condition) i.e., Lipid, A1c, Vit D, CBC, for a future preventative annual visit, these orders would not count toward MDM for this problem visit, correct?
 
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