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using common medical record to code consult

  1. Default using common medical record to code consult
    Medical Coding Books
    You will have to excuse my question. I am currently not doing coding and may not know if things have changed in the past 4 years. When an ER Dr requests a consult is the consulting physician allowed to use the ROS, EXAM
    Family and social history from the exam of the ER Dr. This was for a gastro consult. This is a personal question as I am disputing a level 4 consult done on my husband. We did not want the procedure he recommended and I asked that he call me. He went to see my husband and saw him for less than 3 minutes. I have his progress notes and the written letter that he generated (all this information was obtained from the ER Dr. notes)
    Thanks for your help and I wonder why our health care is rising, as far as I can see this is an example of upcoding and fraudulent billing.

  2. #2
    Well... first off, you say "consult" I do not deem this a consult. Normally the ER physician calls in a "consultant/specialist" but they are not requesting the advise/opinion/expertise of this provider. They are simply "passing the buck" as it's beyond their level of expertise... SO, if the gastro doc that saw your husband billed a level 4 consult, 99244 or 99254. This is incorrect already. If your husband was inpatient, they should have billed a subsequent care code, 99231-99233. If your husband was outpatient, the gastro should have billed 99201-99215. If the gastro admitted him, he should have billed 99221-99223.

    Ok, so, with that said. The next issue... NO the consultant CANNOT use another physician's documentation as their own. They would have to redictate the ROS, PFSH.. and do their own exam. How could a gastro use a ER doc's exam? I certainly would be upset if I had a gastro work up and they used the ER doc's exam because then WHY was gastro called in... there's obviously an issue/problem at hand that the gastro would have to check/exam himself in order to give an accurate assessment/diagnoses. Furthermore, this degrades quality healthcare.

    Now as far as what should have actually been billed by the gastro, I would like to see what he documented... is there anyway you could post his note? (names removed of course)

  3. #3
    Milwaukee WI
    Default Patient privacy
    I'd like to suggest that if Carol and her husband (whose record this is, after all) are comfortable sharing her husband's record directly with AR for some advice on whether the coding is correct, to do so privately, rather than post on this forum. Even without names, we know it's her husband.

    Just my feeling on the matter.

    F Tessa Bartels, CPC, CEMC

  4. Default Information with privacy
    I have already e mailed her privately about the matter.

    thank you

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