Page 1 of 2 12 LastLast
Results 1 to 10 of 14

consult vs referral

  1. #1
    Default consult vs referral
    Medical Coding Books
    Hello,

    We had a seminar last night with a physican that knows alot about E&M coding. I am disagreeing with him on a certain grey area. I would like to have any advice regarding this subject because I have to sell it to him.

    Okay, Senario: Dr. A Family practice, has a patient with hemtachezia, Dr. A sends him to Dr. B surgeon for a colonoscopy.

    Does Dr. B charge a consult visit or a new patient E&M?

    The seminar Dr., says it is a consult. I don't agree because Dr. B is going to assume care of that patient for a known problem. He isn't going to give his advise/opinion and send him back to Dr. A.

    Any feedback or opinion's would be great!

    Becky Werner, CPC, CCS-P

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    I sort of lean toward consultation although I believe it could be better worded. The patient has a dx which is a symptom and it could be that he is asking Dr. B for an opinion of what is causing this symptom, and colonoscopy might help with Dr. Bs evaluation.. On the other hand if Dr. A has determined he wants a colonoscopy so the HE may better make a dx and he needs Dr. B to perform this exam then I agree no consult.

  3. #3
    Default
    Okay, so Dr. B evaluates and does a colonoscopy, let say, he finds colon polyps. He is going to bx them, have a follow up with the patient, tell him how he needs to follow up within so many years but he isn't going to send him back to Dr. A to do anything in regards to this problem because he assume care of the problem and delt with it.

    I believe it is more of a referral. He was referred to Dr. B and Dr. A is expecting Dr. B to evaluate and treat the patient for the condition for which the patient is being referred. The services of Dr. B would not be reporting using consultation codes. On the other hand, if physican A makes a request for a consultation to physican B, it is expected that physican B will provide Dr. A with his or her advice or opinion and that the patient will return to Dr. A for any necessary treatment.

    Let me know what you think?

  4. #4
    Default
    Quote Originally Posted by bwerner View Post
    Hello,

    We had a seminar last night with a physican that knows alot about E&M coding. I am disagreeing with him on a certain grey area. I would like to have any advice regarding this subject because I have to sell it to him.

    Okay, Senario: Dr. A Family practice, has a patient with hemtachezia, Dr. A sends him to Dr. B surgeon for a colonoscopy.

    Does Dr. B charge a consult visit or a new patient E&M?

    The seminar Dr., says it is a consult. I don't agree because Dr. B is going to assume care of that patient for a known problem. He isn't going to give his advise/opinion and send him back to Dr. A.

    Any feedback or opinion's would be great!

    Becky Werner, CPC, CCS-P
    Becky,

    I would have to get further clarification from Dr. A as to his intent, it sounds like a transfer of care for this particular problem, but too could be out of Dr. A's speciality and he sent this pt to a specialist for a consult and treat also.
    Last edited by rthames052006; 06-30-2009 at 10:41 AM. Reason: spelling correction
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  5. #5
    Location
    Columbia, MO
    Posts
    12,531
    Default
    I go by the spirit of the request. Just because the findings of the consult reveal that that Dr. B is better able to address the problem does not detract from the fact that it was a consult from the beginning. Assuming it was in fact a consult.

  6. #6
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    as long as Dr A
    REQUESTS that Dr B see the patient
    REASON (Dr A states to Dr B the reason he's REQUESTING the consult)
    RENDER (Dr B gives his/her advice)
    REPORT (Dr B sends a report of his/her findings back to Dr A)

    then, it's a consult.

    In your scenario - Dr A can't help the patient anymore, it's beyond his help at this point, so he sends the patient to Dr B for "Dr B's" experise - his opinion - basically - "what do you think Dr B, surgery? or some other measures to try to fix the problem first?"... Dr B, knows why he's seeing the patient AT THE REQUEST of Dr A... Dr B examines patient, RENDERS his advice (surgery or not)... and REPORTS back to Dr A "here are my findings" (I think surgery, and we'll take it from there......).....


    I agree with the seminar doctor - I'd call it a consult... the patient is being sent there for Dr. B's expertise/opinion on what to do next.
    Donna, CPC, CPC-H

  7. #7
    Default
    The fact that it is beyond the original doctors ability to handle the problem, he recognizes this and sends them to someone who can handle it, screams transfer of care to me.

    If he can't fix it or won't be following it, even with an opinion from a specialist, how could it be a consult?

    It's not what the specialist documents, you could make any visit look like a consult (believe I have surgeons that do this every day) but the intent is what drives it. If they go back to the original providers note and it doesn't support he wanted an opinion on how to treat this problem, you don't have a consult no matter how good your documentation looks.

    Just my opinion,

    Laura, CPC

  8. #8
    Default
    Okay, I agree with all of this but there is alot of confusion with it. It all depends on how it happens and how it is documented. These senario's happen all the time within our group. Dr. A has his nurse send over the records to Dr. B and Dr. B evaluates and does his surgery or whatever and sends his documentation back to Dr. A.

    So, to code this as a consult. Do I need a written request from Dr. A, not just chart notes? Also, Dr. B has to document that "patient is here for a consult from Dr. A". Also, is just cc: Dr A, at the end of the dictation considered the report?

  9. #9
    Default
    Katmryn78-

    When your surgeons mark a consult and documentation and requests doesn't support a consult, do you mark it down or do you charge the consult whether you agree with it or not?

  10. #10
    Default
    I take it down to established or new.

    The problem I run into with my surgeons is they dictate a letter on every visit for every patient back to the primary care provider. So just picking up a note it would look like a consult when in fact it could be a surgery follow-up 99024.

    You don't have to have a written request from the requesting provider but it must be documented in the consult note and supported by the requesting providers documentation as well.

    If you have a shared EMR the cc should be sufficient for your report back providing the system can track the note and show the requesting provider did get it.

    Laura, CPC

Page 1 of 2 12 LastLast

Similar Threads

  1. Referral to OB
    By Manugal1 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 08-06-2014, 08:55 AM
  2. Referral vs consult
    By cmoon in forum E/M
    Replies: 2
    Last Post: 08-22-2013, 10:07 PM
  3. PT\OT referral
    By veeramani14 in forum Internal Medicine
    Replies: 0
    Last Post: 04-23-2013, 10:28 AM
  4. Self Referral
    By apetruzzo in forum Compliance General Discussion
    Replies: 2
    Last Post: 03-13-2013, 03:47 PM
  5. Consult or Referral
    By swebco in forum E/M
    Replies: 12
    Last Post: 03-13-2009, 08:08 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.