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Help With Consults!!!

  1. #1
    Exclamation Help With Consults!!!
    Medical Coding Books
    I work for an ortho group under the same "group" number, etc....One dr referrs the pt to another one of our docs....would this be billed as a consult or an establ e/m visit??? Any help is greatly appreciated

  2. #2
    To be a consult you need a request for opinion, based on your statement that one doc "referrs" to another doc in the group that leads me to believe it is not a request for opinion.

    Why are they sending them to another member of the group? Do they intend to get the patient back or do they just not handle the issue?

    You may have some that are consults but I would imagine a lot are going to be transfers of care. Unfortunately there is no clear cut answer, they will have to be evaulated on a case by case basis.

    Laura, CPC

  3. #3
    I agree with Laura, and I would also add that when you have a true consult, your physician is asking for an opinion. Generally this means that the consulting physician has some expertise, education, or background that the physician asking for the consult does not have. Keep that in mind when you are thinking about consultations between physicians of the same specialty.

  4. #4
    With consults, wether from within or from the outside, always ask yourself "what is the intent"? If the requestor seeks and opinion and gets a report (e.g., a letter or access to a shared record) with recommendations that would support a consult. If the consensus is "you take the patient from here on" that would be a transfer and in case of a same specialty same group situation would be and established f/u in the outpatient setting.
    It is certainly possible for a same group same specialty provider to ask a collegue from within the group for a consult, this occurs when the collegue has a level of expertise beyond the first provider's in regard to the patients particular problem. I don't work in ortho, but let me try an example. Let's say a patient is seen in follow up for a healing leg fracture by Dr. A. Now this patient complains about "weird sensations in the wrists" (pt's own words for chief complaint). A collegue (Dr. B) is particularly skilled in treating carpal tunnel which Dr. A suspects. Dr. A asks Dr. B to evaluate the patient and to give recommendations how to treat this patient for the wrist problems. Here you have a consult - assuming that both providers do their part and properly document.

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