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New or Established Patient.

  1. Default New or Established Patient.
    Medical Coding Books
    Our providers are pediatric CT surgeons. We get an initial request for a consultation, (we follow the 3 r's of a consult) performs the first stage surgery. The surgeon does all the post-op follow up visits and renders services back to the refering phys. Four months latter the referring phys send back the patient to our surgeons requesting the advice of our surgeon to see if the patient is ready for the second stage surgery. CAN WILL ANOTHER CONSULTATION?

    thank you.

  2. #2
    I believe so, as 4 months later is past the post op period, plus this is actually a new surgery as it is the second stage.

  3. #3
    Charleston, South Carolina
    My concern here is that it was known at first consult to be "staged" procedure(s). If you knew then there would be other "stages" how can you consult again on the same issue?
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

  4. #4
    Milwaukee WI
    Default Eestablished patient
    The patient is clearly an established patient ... but the question is whether this visit is a consult or an established patient office visit.

    It seems to me that the CT surgeon knew after the first consultation that the patient's condition would required staged surgery. As long as this "new" visit is for the same problem and to evaluate readiness for the next stage, I'd say it's an established patient office visit.

    F Tessa Bartels, CPC, CEMC

  5. #5
    I agree with Tessa's statement. It looks like the patient is returning for further treatment as previously evaluated. Ask yourself: does the requesting provider ask your provider's expert opinion on the issue or is the patient sent to continue the care that was already initiated and now goes into the next phase. It is only a consult when the requesting provider seeks an expert opinion on the issue*, otherwise a transfer of care for that specific problem occured and the patient is established.
    (* of course, recommendation and report back must be documented as well)

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