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Is it appropriate to code a consult?

  1. #1
    Default Is it appropriate to code a consult?
    Medical Coding Books

    Is it appropriate to bill a consult in this suituation:

    A patient that was seen at an Urgent Care facility is sent for a consult at an orthopedic facility. The criteria of the 3 R's would be met. Does that seem right that a patient is sent for a consult from a urgent care facility? It sounds like it should be more of a follow up appt. What is your thinking on this? Could you bill a consult in that situation if the 3 R's are met?

    Thanks in advance.

  2. #2
    Daytona Beach, FL
    If the patient was sent to the orthopedist from an Urgent Care I would say that this is [B]not[B] a consult. An Urgent Care is basically like an Emergency Room where the doctors take care of the patient's immediate need and then sends them back to either their own physician or a specialist. They do not do any follow-up care so they are not asking for another physician's opinion, which is a requirement for a visit to be considered a consult.
    Jodi Dibble, CPC

  3. #3
    Monroe, NC chapter
    Thumbs up
    I agree with Jody- this would def. constitute a transfer of care...

  4. #4
    Default Thank You
    Thank you for your advice! I agree that it should not be considered a consult. I just needed some reassurance

  5. #5
    ST Paul, MN
    To further back up the opinion of 'not a consult': is the ortho cc-ing the exam notes to the urgent care? Is there anything in the records stating 'Dear Dr so-and-so, thank you for letting me see your patient...'. If there is nothing of this nature, then the consult code would be incorrect.
    Brian Johnsen, CPC
    St Paul, MN

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