This is from our Medicare Contractor:
Contractors pay for reasonable and medically necessary consultation services when all of the following criteria are met:
A consultation service is distinguished from other evaluation and management (E/M) visits because it is provided by a physician or qualified non-physician practitioner (NPP) whose opinion or advice regarding evaluation and management of a specific problem is requested by another physician or other appropriate source; and
A request for consultation from an appropriate source and the need for consultation (i.e., the reason for a consultation service) should be documented by the consultant in the patientâ€™s medical record; and
After the consultation is provided, the consultant should prepare a written report of his/her findings and recommendations, which must be provided to the referring physician.
If your service doesn't meet these criteria, then the service isn't a consult. It is a new patient E & M visit. The auditors will request records from the referring physician to verify this. Also, insurance company auditors will decide what code should have been used, in terms of coding. In fact, many insurance companies are employing CPC or CCS-P certified personell to conduct audits.Be careful, get educated (go to seminars and read the information on the CMS and Contractor's website) and follow the rules.
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join