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Thread: Re: Consultation Requirements

  1. #11
    Join Date
    Apr 2007
    Milwaukee WI

    Default PCPs don't understand

    AAPC: Back to School
    Verrrry interesting ...
    I'm wondering how many PCPs start referring patients to a different neurologist.

    PCPs really don't understand consultations because they don't use the code and there's no financial ramification for them when the code is misused. In that sense, I kind of like your neurologist's approach - he only takes new patients with a direct contact from the PCP's office calling for the initial appointment and he faxes back a specific form about consultation.

    I think it would be better if he had a choice for the PCP to checkmark and return ... so you could have his current statement (maybe modified a bit) as choice #1, and a different statement about "request to treat a problem needing neurologist's expertise."

    One dermatologist I know has nothing half so detailed as what your neurologist has, but does fax back to the PCP a request/referal form with something along the lines of:
    REQUEST FOR CONSULTATION (evaluation of issue and report back to PCP with recommendations)
    nature of problem:

    REFERRAL FOR TREATMENT (diagnosed problem requires expertise of dermatologist for treatment)
    nature of problem:

    Once she gets the form back she sets the patient appointment.

    I particularly like how she combines Request with consultation, and referral with treatment. In her own little way she's trying to educate the PCPs one doctor at a time.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  2. #12
    Join Date
    Apr 2007


    OMG! I have these same problems. I constantly have try and explain the difference between a consut ansd a referral to my staff. Some people just don't get it. Here is a question I would appreciate some feedback on. Coders in our office are disagreeing about this. If the DR uses a consult code say, 99244, and we know it was not a consult but a new patient we change it. One coder believes you just cross over to a 99204. Others say you have to go up a level. Advice?

  3. #13


    The documentation requirements (meaning numebr of elements needed) are the same for new patient/consult so it should just be able to go from 244 to 204 or vice versa.

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