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Help!!-consult question


Palm Coast, FL
Best answers
I work for a family physician and she is always called in to do the admission of a patient that is going to have surgery- such as knee surgery. She really does not have a reason to admit the patient, but the specialist don't seem to want to admit. How are we suppose to handle this. Is anybody else having this problem. What are medicare guidelines on this.

I am also curious if the specialist are coding consult codes with the surgery codes.

Thanks for any input.

Heather D Unklesbay, CPC, MA
Office Manager
Milwaukee WI
Best answers
Lazy surgeon

Oh, this really gets my hackles up. Why isn't the surgeon doing his/her own work? I know, the surgeon'll say s/he's not getting paid for the Admit -- but s/he IS paid for it! The admit is part of the RVU for the surgery ... just like the post-op care.

The admission H&P is the responsibility of the admitting physician - in this case the surgeon who scheduled the patient for surgery.

If the surgeon is requesting a consultation from your physician for a medically necessary reason ... e.g. patient scheduled for knee surgery, but has diabetes ... then the family physician can code for a consultation.

I'd start insisting that the surgeon in question complete a request for consultation form due to medical necessity, and see those patients in the office a few days prior to surgery.

The surgeon should not be able to bill a consult or admit on the day of or day prior to surgery. (Unless, of course, the E/M resulted in the decision for surgery.)

F Tessa Bartels, CPC, CPC-E/M