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Inpatient admission vs consult

donavon56

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4
Location
Venice, FL
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Is it appropriate for a physician to dictate a hospital admission as a "history and physical" to satisfy the hospital requirements but bill it as a consult if all requirements are met?

Thanks for any input!

Davon
 

kevbshields

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1,101
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Louisville, KY
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Nope. If the Consult results with admission (and the provider creates that order for admission), then the charge is for an initial hospital visit.

See the guideline in the E/M section. I think there's something there on this matter.
 

junebug1969

Networker
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31
Location
Edwardsville, IL
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I always remember the 4 R's of Consultation:

In order to code as a consultation there has to be:
1. Request- consultations have to be requested from the treating doctor
2. Reason- reason for the consultation
3. Rendered- the services rendered need to be documented
4. Report- consultations include a report to the requesting doctor

This is just a simple way that we use to know when it is a consultation. As a rule of thumb, an established patient will not get a consultation from their own doctor.

As stated earlier, if you have an admission resulting from an office visit consultation then you would code for the admission. However, I would look closely at the guidelines to see if in this case you could actually code for an inpatient consultation.

However, as also stated earlier I don't believe that you can because there would not be hospital documentation of the request for consultation. I believe that this is one case in which the consulting doctor would just have to accept the admission code for reimbursement. Thankfully this doesn't occur that often.
 
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