Wiki Help! Consult or New Patient?

[surfroxy223@yahoo.com]

Hello. I work for a pain management doctor and he sees what he thinks are a lot of consults. Most result in some type of management, or a subsequent procedure performed on a later date. My doctor thinks these should be billed as consults since the PTP is still participating in the patients care, he simply attempted to relive the patients pain, say with a standard ESI. I say these should be billed as a new patient appointment because he assuming the care of this specific issue and is providing an additional service other than his opinion. The frustrating part is the facility referring always marks both "referral" and "consult" then gets the patients insurance to authorize the consult code. He is using this as support for his argument that these visits are considered consults. Opinions please? Thanks!

 

[philipwells]

Consultations vs. new patient visits

If a patient is sent to you for an opinion or advice, the encounter may be a consultation service rather than a new patient encounter. CPT defines a consultation as ?a type of service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source.? For example, if you are asked to see a patient for a pre-operative clearance or for evaluation of a medical problem, the appropriate category might be consultation services. Since the same consultation codes apply to both new and established patients, it is not necessary to apply the new patient definition

 

[CodingKing]

Have you done the 3R's test?

http://news.aapc.com/remember-the-three-rs-for-payers-accepting-consults/