Wiki When a Consult is really a Consult

[karenh]

During my CPC training we were told that when a patient is referred to a Dr for a consult if that Consulting physician prescribes medications during that visit That meant the consulting physician was taking over care and therefore the initial visit would not be billed as a consult but a new patient E/M code. I need to know if this is correct and is there any documentation to support the correct billing one way or the other? Thanks for all who help!!!!!

KarenH, CPC

 

[Vsavalia]

Hi

Consultations require a request from a provider or other appropriate source, recommend care or whether to accept responsibility for ongoing care, and a written report from the consulting provider to the requesting provider/appropriate source.

I hope this helps

Regards

Vimal,CPC,CPC-H

 

[smiller]

This might help also, the "Three Rs" of consultation codes: request, render and reply...

 

[MarcusM]

In the scenario you describe, the specialist will still bill the initial visit as a consultation with any subsequent visits as an established patient since he is treating a specific condition. The specialist should still copy the referring doctor on all visits so the referring doctor can track progress on this specific condition.