Each inpatient stay allows one consultation per specialty. Who is the admitting physician? Is the admitting physician also Family Practice. In the physician orders what exactly does the order state is the reason for the consultation?
What I am finding when I review the inpatient consultations, which includes the actual orders in the chart, it they are not really consultations. The referring physician/admitting physician is wanting the Family Med/Internal Med physician to "manage" the co-morbidities for that patient.
This all goes back to the orders and what the requesting physician states is their intent. Whether you meet the three "R's" for a consultation really does not matter if the intent is transfer of care for management of co-morbid conditions. The admitting physician is usually not wanting the "advice or opinion" relayed back to them for them to make the treatment decisions. The admitting wants to handle the surgical condition or what ever condition they admit for. They want a general practitioner to manage the other conditions.
CPT states that additional (subsequent) visits should be billed as subsequent visits following a true consultation. CPT deleted the follow up consultation codes a few years ago.
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