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Consultation Twist

  1. #1
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    I have an Urologist who saw a patient with kidney issues. Urine culture came back with staph coag neg only sensitive to Vancomycin. The doctor called Infectious Disease, who recommended IV therapy. The Urologist has this in his notes. Appt was made with ID the next day and treatment started. ID now wants to bill a consult. I would think that it would be a new patient visit. All because of the phone call...it's tough explaining things like that. In defense of billing a consult, the ID doc says "I was asked to see the patient to render an opinion regarding whether or not the positive urine culture represented a true infectioun requiring treatment or not. I felt it did and started treatment." Because they were asked, though it was over the phone, then they saw them for workup and evaluation, could it possibly be a consult? Sometimes when you go round and round with this, you start to wonder...

    Thanks.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  2. #2
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    Quote Originally Posted by bpct6501 View Post
    I have an Urologist who saw a patient with kidney issues. Urine culture came back with staph coag neg only sensitive to Vancomycin. The doctor called Infectious Disease, who recommended IV therapy. The Urologist has this in his notes. Appt was made with ID the next day and treatment started. ID now wants to bill a consult. I would think that it would be a new patient visit. All because of the phone call...it's tough explaining things like that. In defense of billing a consult, the ID doc says "I was asked to see the patient to render an opinion regarding whether or not the positive urine culture represented a true infectioun requiring treatment or not. I felt it did and started treatment." Because they were asked, though it was over the phone, then they saw them for workup and evaluation, could it possibly be a consult? Sometimes when you go round and round with this, you start to wonder...

    Thanks.
    Pam, as I understand your question, the short answer is yes, the ID service can be a consult.

    Pg. 14 of 2009 CPT says, "A The physician consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit.

    The written or verbal request for a consult may be made by a physician or other appropriate source and documented in the patient's medical record.".
    (key word "verbal" here)

    The ID doc should identify the requestor and reason for the consult in the consult chart note, as well as document evidence of a written report sent to the requestor.


    Hope this helps,
    Will
    CPC, CPC-H
    Coding Compliance Auditor

  3. #3
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    The call from the Urologist to ID was Dec. 1. The Urologist told ID of their findings and got the ID's opinion (to start outpatient IV antibiotic treatment). On Dec. 2nd, the ID saw the patient and did the treatment. Would the visit on Dec. 2nd really be a consult?

    I understand that she can initiate treatment but does she have to see the patient, do the assessment and render the opinion all within that visit for it to be a consult or if she renders her opinion the day before over the phone, can her actual visit with the patient the next day still be a consult?
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  4. #4
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    Quote Originally Posted by bpct6501 View Post
    The call from the Urologist to ID was Dec. 1. The Urologist told ID of their findings and got the ID's opinion (to start outpatient IV antibiotic treatment). On Dec. 2nd, the ID saw the patient and did the treatment. Would the visit on Dec. 2nd really be a consult?

    I understand that she can initiate treatment but does she have to see the patient, do the assessment and render the opinion all within that visit for it to be a consult or if she renders her opinion the day before over the phone, can her actual visit with the patient the next day still be a consult?
    In order to report a consult code (or new patient code for that matter) on the same day as the IV tx., she would have to perform and document the required elements of the codes (history, physical exam, medical decision making).

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