AAPC - Back to school
Results 1 to 4 of 4

Thread: consult?

  1. #1

    Default consult?

    AAPC: Back to School
    If a physician refers a patient to a surgeon and the surgeon decides on surgery-- can you charge for a consult and the surgery?

  2. #2
    Join Date
    Apr 2007
    North Carolina


    B. Consultation Followed by Treatment
    A physician or qualified NPP consultant may initiate diagnostic services and treatment at the initial consultation service or subsequent visit. Ongoing management, following the initial consultation service by the consultant physician, shall not be reported with consultation service codes. These services shall be reported as subsequent visits for the appropriate place of service and level of service. Payment for a consultation service shall be made regardless of treatment initiation unless a transfer of care occurs.

    (Page 53)


    Modifier 57: Decision for Surgery
    An E/M examination coded with modifier 57 indicates a visit that resulted in the initial decision to perform a major surgery. It is used the day before or the day of major surgery. Surgeries that have a 90-day follow-up period are considered major surgeries. When coding modifier 57, ensure that the patient’s records clearly indicate when the initial decision to perform the surgery was made. Do not use modifier 57 with an E/M service performed on the same day as minor surgery

    Modifier 25 would be attached to the E/M when performing a minor procedure (assuming they are provided on the same day).


  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Referral or Request for consult?

    Bess begins: If a physician refers a patient to a surgeon (emphasis added by FTB)

    The "red flag" to me is "refers." If the physician knows the patient needs surgery and is sending the patient to a surgeon for the procedure, then you do NOT have a consult.

    If the physician asks the surgeon for a consultation regarding X problem, and on evaluation of the patient the surgeon determines that surgery is necessary, then you have a consult. And, yes, even if the surgery is performed that very day, you can still code the consult (with -57 modifier to signify the decision for surgery).

    I used to explain it to my orthopaedic team this way ... if the pediatrician sends a patient to you because the child's leg is broken and the pediatrician wants you to treat the fracture, it's not a consult. If the pediatrician asks for your opinion on how to manage a scoliosis that he has noted, it's a consult, even if you decide that the condition warrants further treatment by you (up to and including spinal fusion).

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 01-22-2009 at 01:22 PM.

  4. #4
    Join Date
    Apr 2007
    North Carolina



    Tessa is dead on with her post. I assumed that the consult, itself, was not in question but whether or not you could charge for both. My answers are more direct whereas other coders elaborate. I can always count on Tessa to highlight on the "gray" areas. Thanks Tessa...I sure wish I could get this reputation glitch worked out. You deserve Kudos!

Similar Threads

  1. ER Consult vs Inpatient Consult
    By lcouto in forum Emergency Department
    Replies: 1
    Last Post: 10-22-2015, 10:08 AM
  2. E/M OBV Consult converted to Inpt Consult
    By AmandaHartman in forum E/M
    Replies: 1
    Last Post: 06-13-2014, 10:36 AM
  3. Billing OV Consult vs Hospital Consult
    By crowemd in forum Auditing General Discussion
    Replies: 1
    Last Post: 02-20-2012, 02:02 PM
  4. IP consult
    By cchilva in forum E/M
    Replies: 3
    Last Post: 06-16-2009, 06:32 AM
  5. Replies: 1
    Last Post: 01-24-2008, 01:16 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.