IP consult VS Transfer of Care ?


Cameron, NC
Best answers
Hello fellow Co-workers

I work in a multi-speciality clinic that does ORTHO, GYN, ENT, NEURO, URO, General Surg, and Vascular.

Say a patient is picked up as a result of an ER /admitt and the ER doc wants a Surgical opinion, we assume the care of the pateint as we took them to surgery. The attending admitted the patient already, they are IP status. Would We be able to bill the IP Consult or would this be Transfer of care?

I need your input and if you have any references to this for me to give my Physicians. We are doing Audits on Consults. IP is ?????

thank you

Kathy Hoffman CPC
North Carolina.


Albertville, MN
Best answers
Here is an excert of communication from a physician who had questions regarding consultation "intent." The Medicare Carrier which the state I work in is WPS (Wisconsin Physician Services www.wpsmedicare.com). When you go into the website, search "consultation intent" and an excellent article should come up. I use this for education with physicians.

A) "Commonly in my practice, pt will be seen by the surgeons and they will think the patient is not a surgical candidate and they would send the patient to me for non-surgical care. That means that all these would be a new patients but not a consult."

I agree with your statement. The surgeons are not going to see the patient again and treat with your advice or recommendations. They are sending the patient to you for further non-surgical management. This would be a new patient visit (99201-99205) if you have not seen that patient in the last 3 years or anyone else in your specialty. If you have seen the patient before, then you would use the established patient visit codes (99212-99215).
B) "Most often when the patient is referred to me or the surgeons, that means that the primary care doctor can not manage it and would like further management of the condition by the specialist.

If the requesting provider sends the patient to you for treatment, then again, it would be new/established patient visits. The requesting provider is asking you to take over/management of this particular problem because you have expertise in this area.

C) "...what if the requesting physician is not documenting any intent..."

I admit, this is a tough call. I really don't have a concrete answer for you. What I am hoping is that there is something in writing by way of a letter, phone call, inpatient note from the requesting provider. With possibly no intent documented, I would rely on you for your judgement on this, because I am not a physician. Only you know what goes on.

D) "...what if while seeing a new patient on referral, the consulted physician thinks that he would like to manage it."

I would recommend a consultation for this situation. This is because, when the patient comes in, you don't know right away if you plan on treating this patient until after you have evaluated and then you decide to initiate treatment to the patient.

I hope this is helpful in explaining "intent" in a consultation.
Take care,
acw, CPC, CPC-E/M