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Consult issue

  1. #1
    Default Consult issue
    Medical Coding Books
    I am having a day today, any help or opinions will be greatly appreciated.

    Here is my question.
    Both doctor and pa see a patient in the office on the same day.
    Doctor does a very brief history and refers to the pa note for full history and physical then documents the medical decision making piece.
    PA documents a comprehensive history and detailed exam and references doctors note for the MDM piece.

    This is an outpaitent consult. Neither meet the requirement to bill based on the 3 of 3 requirements for a consult and per CMS guidelines consults can not be split/shared. What would be the most appropriate way to bill this? I am leaning towards 99499 under the doctor but submitting both providers notes.

    Again any insight is welcomed.


    Laura, CPC

  2. #2
    Milwaukee WI
    Default If it's an established patient

    If it's an established patient you could also use 99211-15 based on 2/3 key elements. I'd code it to whichever of them audits out highest.

    If it's a new patient, then I think you are stuck with 99499. I'd be inclined to bill under the PA because that is who performed the exam and the more extensive history (still include both notes).

    And try to educate these providers as to how they are sabotaging themselves by doing this.

    Hope that helps

    F Tessa Bartels, CPC, CEMC

  3. #3
    Default Thanks it does help
    I had a meeting with just the doctors yesterday and they are not happy with the idea of having to actually do all the work themselves (these are new patients that should be consults). I get the classic "This is how everyone does it". I really hate that. It doesn't help that they have an outside agency of "experts" in their specialty giving them bad information. Calling yourself an expert at something because it is all you do doesn't make you an expert in my book. Just because you only do one specialty doesn't mean you are doing it right. They gave them a "cheat sheet" for E/M. All it consisted of was the 1997 cardio single system exam and they wrote a note beside each level of exam with what level of consult they equal. I have no idea how they are to decide between a 4 and 5 or the fact that consults are based on all 3 key components not just exam, but who am I to question? Sorry, guess I needed to vent.

    Again thanks for your help.

    Laura, CPC

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