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Consultation vs New patient

  1. Question Consultation vs New patient
    Medical Coding Books
    I recall reading in a Coding Edge article that stated if a physician immeadiately treats a patient, it is no longer a consultation. Am I losing my mind? Is there any truth to this? I am debating with one of my docs (based on this article) that if he puts a cast on or does an injection, this would now be a new patient. What have I gotten myself in to? HELP!!!

  2. #2
    North Carolina
    B. Consultation Followed by Treatment

    A physician or qualified NPP consultant may initiate diagnostic services and treatment at the initial consultation service or subsequent visit. Ongoing management, following the initial consultation service by the consultant physician, shall not be reported with consultation service codes. These services shall be reported as subsequent visits for the appropriate place of service and level of service. Payment for a consultation service shall be made regardless of treatment initiation unless a transfer of care occurs.


    So...if the intent of the consult was to render an opinion and he initiated treatment in the same visit, it still could be a consult (assuming all the other components are met). Ongoing mgmt...(as stated above) would yield an established visit.
    Rebecca CPC, CPMA, CEMC

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