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Consult vs New patient

  1. #1
    Default Consult vs New patient
    Medical Coding Books
    If a consult is taking over the care of the patient, is the visit still considered a consult or would it be coded as a new patient?

    Thanks for any help.

  2. #2
    Default
    actually I just received my new CPT 2008 today...I think it better explains this situation and I believe the answer is to code it as a consult, the second visit would be an established patient.

    Is this how you see it?

    Thanks for any help.

  3. #3
    Thumbs up
    Yes, you are correct as long as the criteria for a consult is met first. The consult must be requested by another doc, then the consultant must reply in writing as to the findings and recommendations. If, after all that the consultant takes over care, regular established pt visit codes apply. Hope this helps! Now, I am posting a question. If you have any idea how to handle it, I would love to hear from you!

  4. #4
    Default
    Im a little confused. Why would that be coded as a consult? If you are taking over care of a patient, i would code that as a new pt. Maybe i am forgetting something but i'm thinking that a consult is when you give advice or an opinion to a requesting provider who will still manage the problem....if you take over care, you are taking that patient as your own...... ????
    Dawnelle Beall, CPC, CPMA, CPC-I
    Licensed AAPC PMCC Instructor
    AAPC ICD-10CM Certified Trainer
    Previous AAPC Local Chapter President & VP

  5. #5
    Location
    St. Louis, Missouri
    Posts
    262
    Default
    I agree, taking over the care of a patient would be considered a new patient visit. A consult is asking for an opinion and you report your findings back to the requesting provider.

    Melissa Blow, CPC

  6. Default
    Quote Originally Posted by 1015378 View Post
    Im a little confused. Why would that be coded as a consult? If you are taking over care of a patient, i would code that as a new pt. Maybe i am forgetting something but i'm thinking that a consult is when you give advice or an opinion to a requesting provider who will still manage the problem....if you take over care, you are taking that patient as your own...... ????
    It should be viewed as a consult unless the criteria for a consult is not met.

    What you should have is a written request from a provider (say family practice), that is requesting an opinion of a specialty provider (say urology), for a condition (maybe frequent urination).

    The specialty physician (urology) will see the patient and review medical records and the patient and should come to a conclusion. The specialty physician consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit.

    The specialty physician (urology) must reply in writing about the findings and results of the visit. This may just be recommendations of treatment or a statement to assume care for a particular condition. This would go back to the requesting physician (family practice).

    Start at the highest level of codes you think it might be, a consult in this case. If the documentation supports a consult, then it is a consult.

    If the documentation does not support a consult, but does support a new patient, then it is a new patient.

    Just keep working down the possibilities when in doubt, but I would start at the highest level.

    I hope that helps some.

  7. #7
    Default
    This has come up again today for me. I thought the rule for billing a consult is the three R's...Request from primary, Report from specialist to primary, and Recommendations for treatment. In our case, we are the specialist. We have been coding consults because we meet this criteria BUT we also treat the patient (pain management/anesthesiologist). Now Medicare is questioning every consult we bill for.

  8. #8
    Default
    If the provider ever treats the patients then it is not considered a consult but considered a new patient. Most of the time consults are actually referrals. Be careful when coding these.

  9. Default re:consult
    For me, I focus on the intent of the visit. If the PCP is requesting the opinion of the specialist it is a consult. Even if the specialist orders labs, begins treatment, or sees the patient for the problem in follow up later the original intent of the visit is taht the PCP was looking for the specialist's opinion.

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