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Hospital consults for established patient??

  1. #1
    Default Hospital consults for established patient??
    Medical Coding Books
    One of my Md's saw this patient in house. He is trying to bill for a consult, but the patient is already established within the group. I dont think he can bill a consult UNLESS another MD requests it, or it is entirely new dx(patient has cancer) is this correct? Can anyone shed some light?? Oh and if you have a link to provide that will help, that will be GREAT.
    Thanks so much !

  2. #2
    Default Abn
    Question: Would an ABN be required for drugs (example: a chemo drug that require 4 units)Would the units be required or would an ABN be needed at all?

    Thank you for your time

  3. #3
    Default
    I have been billing chemo for some time, and the only time I have used a ABN is if the drug is not covered by Medicare. Most chemo drugs are approved by Medicare
    Hope this helps

  4. #4
    Default
    Its not a consult if the referring doctor is not asking a question. Its not a consult if there isn't a new diagnosis or problem ie such as an addtional primary cancer. Its also not a consult if there is no report back to the doctor. I hope this helps have a great day

  5. #5
    Default
    I have 4 years of chemo coding experience the only time our practice has an abn signed is when the diagnosis is not covered for the drug given. Usually a preauthroization and be used if the doctor can provide medical necessity. Medicare puts out the compendia that has a list of drugs that are covered for which diagnosis. I hope this helps.

  6. #6
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    Milwaukee WI
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    Default Hospital Consult
    Quote Originally Posted by maitri1970 View Post
    One of my Md's saw this patient in house. He is trying to bill for a consult, but the patient is already established within the group. I dont think he can bill a consult UNLESS another MD requests it, or it is entirely new dx(patient has cancer) is this correct? Can anyone shed some light?? Oh and if you have a link to provide that will help, that will be GREAT.
    Thanks so much !
    Whether the patient is established makes no difference. And there's no requirement for a new diagnosis either. The key is whether the admitting physician has requested the advice/opinion of your MD (I assume the patient's PMC) about management during the hospital stay. There is NO need for a separate report to the requesting physician for inpatient consultations, as the hospital record is presumed to be a shared record. (Of course, if your consulting physician goes back to his office and writes up his report there and not in the hospital record, then yes, he does need to send the report to the requesting physician.)

    Of course if your situation doesn't follow the scenario as I've painted it, then perhaps you are right, it may not be a consultation.

    I can access our hospital records to find the "order" for the consult when I have a question. You may have to check with the hospital records to clarify.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 04-22-2009 at 02:01 PM.

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