Wiki Referring within the same practice

[kenzie44]

I work for an Orthopaedic practice of 18 physicians, 3 PA's, and outpatient rehab. Each of our physician's specialize in a different area's of the body. Is it possible for our physician's to refer to each other and charge it as a consultation with the same diagnosis even though the patient is established under the same tax id number?
Second question: Can our physician ask another physician within the practice to consult an established patient with a different a different diagnosis and charge a consultation?
Thank you so much!
Mackenzie CPC

 

[RebeccaWoodward*]

Yes...

We have orthopods that seek the opinion of our hand surgeon. Diagnosis shouldn't be an issue as long as long as the three R's are met (request, render, report).

Consultations Requested by Members of Same Group
Carriers pay for a consultation if one physician or qualified NPP in a group practice requests a consultation from another physician in the same group practice when the consulting physician or qualified NPP has expertise in a specific medical area beyond the requesting professional's knowledge. A consultation service shall not be reported on every patient as a routine practice between physicians and qualified NPPs within a group practice setting

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

 

[FTessaBartels]

Request opinion vs transfer care

Rebecca is correct and (as always) has a great link for further info.

I'm going to try to simplify with some examples.

If the knee specialist is requesting the opinion of the spine specialist as to whether the patient has spinal issues that may be affecting the knee, then the spine specialist should probably be coding a consultation.

If the knee specialist is referring the patient to the spine specialist because he(knee specialist) doesn't deal with spinal issues, then it's a transfer of care. And the proper code would be an established patient visit.

Does that help clarify?

F Tessa Bartels, CPC, CEMC

 

[jstanc05]

Stereotactic Services - Physician same practice but different facility

Question- If a provider from the same radiation practice is treating a bone lesion with external beam (2D plan-77307 & 77412 treatment code) and the patient also has a liver lesion that needs to be treated with SBRT (77295 3D plan & 77373 treatment code) but the current facility does not offer SBRT and the provider has to refer the patient to another provider (within the same practice) at a different facility (different NPI/Taxid). Can the physician from both locations bill a clinical treatment plan, even if both lesions were mentioned at the original consult?

It has been mentioned that SBRT cannot be captured for the liver lesion because the femur and the liver were both mentioned in the original consult note-- The argument is that the femur and the liver will be over 5 treatments and not billable as SBRT - However in this case the patient is being treated at one location for the femur and a second location for the liver. Would the practice be able to bill two separate and distinctive plans ( two separate physicians and two separate facilities)