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Consult Uh OH

  1. #11
    Default consultation
    Medical Coding Books
    Quote Originally Posted by katmryn78 View Post
    Something else to think about.

    In your situation when the specialist doesn't treat the patient and sends them back to the ER doctor, you are basing the coding of a consult on the outcome of the visit. Consults are based on intent, not outcome. Any provider can get a transfer of care and refuse to continue care after seeing the patient. That doesn't make it a consult.

    Laura, CPC
    Well, that's true, but the consult was still there. The requirements, and documentation met, so it's still a consult. Now, if Dr. ER said, please come take care of this patient instead of saying please come see what you think, then it's a transfer and that would stand also, no matter the outcome.
    Your right, it's all about intent and I don't feel that if the documentation is there that CMS can say it's not a consultation without something to back that up. I guess all I'm saying is the clarification needs to come from higher up at this point as we will be able to argue this for awhile yet. Documentation, at this point, is the key. Intent is the guiding factor.

  2. #12
    Location
    North Carolina
    Posts
    3,126
    Default
    While this particular scenario may seem a little muddy as far as the intent, someone I greatly admire shared this with me.

    There are still many cases where the ED physician is asking for an opinion, usually regarding whether the patient's presenting problem is related to a certain body system that pertains to a certain specialty. For example, chest pain can be caused by several things—respiratory distress, coronary pathology, hiatal hernia, etc., each of which is handled by a physician of a different specialty. The ED provider may not feel comfortable making the final dx, and so will make their best guess as to which one is the likeliest candidate and usually call that specialty in first to provide an opinion. Let's say the ED provider calls in Cardiology to provide an opinion as to whether or not the problem is a cardiological one. The ED provider does not KNOW that the Cardiology provider coming to the ED as a result of their request will be taking over because they don't even know yet if the patient's problem is cardiological in nature—that's the whole point of asking for the cardiological opinion/consult. Let's say in this situation that the cardiologist consultant provides the opinion that the patient's problem is NOT in fact related to any coronary pathology that they can find. At this point, the ED provider may choose to discharge the patient, order add'l tests, or consult another specialty.

    So because of the fact that ED providers often request opinions from specialists in order to rule out certain conditions and to help them determine who they should call or consult next, the services they request will often be accurately billed by the requested provider as a consult.

  3. #13
    Default consultation
    Quote Originally Posted by rebeccawoodward View Post
    While this particular scenario may seem a little muddy as far as the intent, someone I greatly admire shared this with me.

    There are still many cases where the ED physician is asking for an opinion, usually regarding whether the patient's presenting problem is related to a certain body system that pertains to a certain specialty. For example, chest pain can be caused by several things—respiratory distress, coronary pathology, hiatal hernia, etc., each of which is handled by a physician of a different specialty. The ED provider may not feel comfortable making the final dx, and so will make their best guess as to which one is the likeliest candidate and usually call that specialty in first to provide an opinion. Let's say the ED provider calls in Cardiology to provide an opinion as to whether or not the problem is a cardiological one. The ED provider does not KNOW that the Cardiology provider coming to the ED as a result of their request will be taking over because they don't even know yet if the patient's problem is cardiological in nature—that's the whole point of asking for the cardiological opinion/consult. Let's say in this situation that the cardiologist consultant provides the opinion that the patient's problem is NOT in fact related to any coronary pathology that they can find. At this point, the ED provider may choose to discharge the patient, order add'l tests, or consult another specialty.

    So because of the fact that ED providers often request opinions from specialists in order to rule out certain conditions and to help them determine who they should call or consult next, the services they request will often be accurately billed by the requested provider as a consult.
    Well Said. Thanks!

  4. #14
    Talking
    Thank you all so much for your input and honestly I can see both sides a lot more clearly. Basically it will be extremely dependent on the situation. While we do not often see ER patients just the mere thought of doing it wrong was really bugging me. Thanks again so much for taking your time to offer your opinions. I am not here as often as I would like to be but I do value the opinions of my peers very highly.

    You guys have been phenomenal and given me loads of info.

    P.S. The rep never said specifically that an ER doc couldn't request a consult but that they did not meet the qualifications of a requesting physician. (I think she was inferring that there would be no return report which I seriuosly disagreed with if there is a shared record).

    I hope to see you at the regional in VA!!!!
    Kimm Hall CPC, CMSCS, CGCS

    If you live to regret then you have not learned lifes lessons.

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