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Consultation Letters

  1. Default Consultation Letters
    Medical Coding Books
    Our doctors are often so busy that they do not dictate their consultation report until after the surgery. They actually explain their complete course of treatment. I think that this would substantiate a transfer of care rather than a consultation because they are not giving their opinion prior to performing surgery. Am I correct?



  2. #2
    Milwaukee WI
    Default Why is patient sent to you?
    If the patient is being sent to you to have surgery ... then it's not a consult.

    If the surgeon is seing a patient in consultation, and decides that surgery is needed ... even if surgery occurs the same day ... then it's a consult. The surgeon's dictation on the consultation should be specific to the decision for surgery and not cover what happened during or after the procedure.

    I know they are busy. I know it's a headache to dictate two notes. But if they want to be correctly paid for the services they render, that's how they need to document.

    F Tessa Bartels, CPC, CEMC

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