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Thread: Inpatient admission vs consult

  1. #1

    Default Inpatient admission vs consult

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    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!

    Davon

  2. #2
    Join Date
    Apr 2007
    Location
    Louisville, KY
    Posts
    1,100

    Default

    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.
    Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I

  3. #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
    Join Date
    Apr 2007
    Location
    Atlanta, GA
    Posts
    59

    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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