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Thread: Consults

  1. #1
    Join Date
    Apr 2007

    Default Consults

    AAPC: Back to School
    I work in a urology office and one of my docs likes to charge a consult for vas consults. we have told her several times that they are a new patient because they assume their care after seeing them. Is this correct or not?

  2. #2
    Join Date
    Apr 2007
    North Carolina


    If your physicians opinion is being sought, then a consult can be charged. If a consult is being rendered in addition to treatment, you can still charge a consult for that initial visit....

    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.

    Transfer of Care
    A transfer of care occurs when a physician or qualified NPP requests that another physician or qualified NPP take over the responsibility for managing the patients’ complete care for the condition and does not expect to continue treating or caring for the patient for that condition.
    When this transfer is arranged, the requesting physician or qualified NPP is not asking for an opinion or advice to personally treat this patient and is not expecting to continue treating the patient for the condition. The receiving physician or qualified NPP shall document this transfer of the patient’s care, to his/her service, in the patient’s medical record or plan of care.
    In a transfer of care the receiving physician or qualified NPP would report the appropriate new or established patient visit code according to the place of service and level of service performed and shall not report a consultation service.

    So...with this being said. If the requesting provider is seeking an opinion, your provider can bill a consult. If the requesting physician is transfering this patient to you for managing the care...bill the appropriate office visit (99201-99215)


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