• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Is billing a consult correct for this scenario?

Create Wiki
1

1073358

Expert
Messages
454
Location
Merrill, WI
Best answers
0
If a patient is admitted to the hospital for a heart condition and the patient has end stage renal failure and the cardiologist calls in the nephrologist, and the patient is a person who the nephrologist has already been treating on the outpatient side, is it appropriate for the nephr. to bill a consult if the request, reason, report criteria are met?
 
1073358 said:
If a patient is admitted to the hospital for a heart condition and the patient has end stage renal failure and the cardiologist calls in the nephrologist, and the patient is a person who the nephrologist has already been treating on the outpatient side, is it appropriate for the nephr. to bill a consult if the request, reason, report criteria are met?
Click to expand...

YES, Nephrologist can bill for a consult as long as he is not the admitting physician...

YTH,CPC
 
I am so glad you asked that question. I work for a group of Nephrologists and we used to always bill for a consult in that situation. But, our office manager went to an RPA meeting last year & came back & told us that if an established ESRD patient is admitted for (say heart condition) & the nephrologist is asked to consult for Renal Management, then the nephrologist has to code that as a subsequent visit. Our docs are not real happy about this!:mad: Now, if the established patient is admitted to hospital for maybe sepsis due to infection in catheter, then the nephrologist, I beleive, can bill for a consult. It can get a little confusing, even for the doctors!!:confused:
Let me know if you hear anything different.
Kathy, CPC-A
 
Disagree

I disagree with that scenario about the nephrology consult. I don't know if your manager misunderstood the speaker, or if they were given bad information.

I believe she is speaking on transfer of care, which is another situation altogether. If the nephrologist is NOT the admitting MD, he/she may bill for one consultation per hospitalization if his/her advice or opinion is being sought.
The 3 R's: request, render, and report are the only things required to bill a consult.

http://www.aafp.org/fpm/20070300/45aref.html

Medicare's online provider manual (section 30.6.10) deals extensively with this topic:
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
 
You must log in or register to reply here.
Top