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H&P VS Consult


Pico Rivera, CA
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I have a physician who performs a consultation in the office and dictates to the hospital line and adds a note's that this also serves as the H&P for patients upcoming procedure. I have been billing for a office consult. Is this correct?
Thanks for your help in advance.


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That's the way our practice has been told to handle this situation. Just be sure that your consult documentation requirements are met.


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I would bill it as a consult if, 1st there is a request from the surgeon, verbal or written, a written answer to the surgeon concerning the findings in our chart and then most importantly, the consult was done because the surgeon required the expertise of my doc to determine that the patient was able to have the surgery. If the patient was say 25 with no ailments and going into surgery to have a fracture fixed I would not bill a consult code, just an H&P. There is really no need for an expert opinion with this patient. However if I had a PT with CAD or HTN, then I would bill the consult code, the surgeon is requesting the expertise of my doc as to whether the patient is able to undergo the surgery. His written report would advise the surgeon of his findings. There are some good articles concerning this on the CMS site if you would like to review this more. The following is from there:

"A preoperative consultation at the request of a surgeon is payable if the service is medically necessary and not routine screening;"

The medically necessary part is what I look out for. Hope this helps.

Kate, CPC