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Inpatient admission vs consult

  1. Default Inpatient admission vs consult
    Medical Coding Books
    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!


  2. #2
    Louisville, KY
    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.

  3. Default
    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.

  4. #4
    Thumbs up
    I really liked the way you put the Rules... I have copied and am going to use and commit to memory....

    Thanks a bunch
    Felicia A. Thomas, CPC
    Atlanta, GA

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