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consults

  1. #1
    Lightbulb consults
    Medical Coding Books
    We have a referring doctor that is sending a consult to us. We seen the patient 3 1/2 years ago for a different dx. Can we bill a consult?
    thanks
    patti

  2. Default
    Absolutely! There are very specific rules about consults though. Hopefully you have a "Professional" version of the CPT manual and can read the "Consultation Visits" guildlines before codes 99241-99245. Basically a written request for the consult from the referring Physician needs to be put into the patient's medical record. Just a quick typed note signed by the referring Doc asking your Doc to see his patient for whatever reason. Then once your Doc has dictated his office visit he needs to address a letter back to the referring Doc sharing his opinion and any services that were ordered or performed and a copy of this should be put in patient's medical record. Pretty easy!

    Jenna, CPC, ACS-EM

  3. #3
    Question
    Quote Originally Posted by Meggett View Post
    Absolutely! There are very specific rules about consults though. Hopefully you have a "Professional" version of the CPT manual and can read the "Consultation Visits" guildlines before codes 99241-99245. Basically a written request for the consult from the referring Physician needs to be put into the patient's medical record. Just a quick typed note signed by the referring Doc asking your Doc to see his patient for whatever reason. Then once your Doc has dictated his office visit he needs to address a letter back to the referring Doc sharing his opinion and any services that were ordered or performed and a copy of this should be put in patient's medical record. Pretty easy!

    Jenna, CPC, ACS-EM
    We have already seen the patient on another consult from same referring doctor but it has been 3 1/2 years and he is now being referred with a new diagnosis. I was not sure how or if the new patient time limits apply or if the one consult rule applies.

  4. Default
    Either way it is a valid consult. Patient is "new" if it's been 3 yrs since last visit - plus the new diagnosis and request that your Doctor evaluate this new dx is valid for a consultation.

  5. #5
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    If an additional request for an opinion or advice, regarding the same or a new problem with the same patient, is received from the same or another physician or qualified NPP and documented in the medical record, the Office or Other Outpatient Consultation (new or established patient) codes (99241 – 99245) may be used again. However, if the consultant continues to care for the patient for the original condition following his/her initial consultation, repeat consultation services shall not be reported by this physician or qualified NPP during his/her ongoing management of this condition.

    http://www.cms.hhs.gov/manuals/Downloads/clm104c12.pdf

    30.6.10

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