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What constitutes a consult...

  1. #1
    Default What constitutes a consult...
    Medical Coding Books
    I just had a very animated meeting (translation: surgeon yelling at me) about consultation codes.

    Per him, I do not know anything about them and until I have been on the floor with him I am to keep my mouth shut. According to him the only way care can be transferred to him is by another surgeon in his field. Every other patient that is sent to him is a consult, period, end of discussion.

    I am not questioning my understanding of consults, this provider is under scrutiny and has a 97% error rate on E/M coding, obviously I am not the one that doesn't know anything about E/M since I differ in "opinion" with him and he has such a wonderful track record.

    What I am questioning is has anyone else dealt with this mentality before? How do you deal with this? How can I make him see the light? Of course, if consults go away this will be a non-issue, but for now he is trashing my credibility and basically is after my job. I am not the only one he acts like this towards so I'm not taking it personally, but this is truly a first for me. I have never had a surgeon, or any provider for that matter, act like this and I have dealt with some really nasty ones before, no doubt about that. I am hoping someone else out there has "been there, done that" and can help me out.

    Oh, on a side note, I just found out today that he directed the physician assistants to NOT sign their documentation because I told them they had to.


    Laura, CPC, CEMC

  2. #2
    Smile Arrogance
    You know Laura it's sad we have to deal with Physicians like that but unfortunately sometimes it is a part of our job. I literally had to learn to keep my mouth shut (wanted tape LOL) and listen, nod and then when it was over just walk away. I also had to do whatever he insisted on because his wife also worked there and made sure I followed whatever he said. At one point I even prayed for an audit (now that was mean of me!!!!). After 4 years of this I did finally find a job that I love and got away from all that stress. I wish you luck and I know it's very hard to deal with but there is a light at the end of every tunnel!!!!

  3. #3
    North Carolina

    I have "been there, done that". Without going into details, I sought help from the executive directors and medical director. I presented my case with beginning to end CMS compliance material. The information was irrefutable. Yes...there are some gray areas within the consultation arena but for the most part, the rules are simple. I don't know that you can make him "see the light" if he chooses to ignore your recommendations. I would rally your administration together and have a heart to heart. We do disagree on some topics but one thing we can agree are well versed in Medicare compliance issues. You make one heck of a coder and it's sad that he is not taking the time to listen to your valuable information. It's his hind end your looking out for...but...and without trying to sound harsh...If OIG pays him a visit, he may have lots and lots of time in the future to think about what you tried to tell him.
    Last edited by RebeccaWoodward*; 09-23-2009 at 02:09 PM. Reason: spelling

  4. Default
    Oh man, that brings back memories. One of my coders and I (I was the manager at the time) had a new physician join our practice and he told both of us off in the worst sort of way. He told us "How would you know how to code, you're not a physician, you don't know what I do". (he had come from a practice where the physicians coded their own work and in our practice we had coders do the coding.) He wasn't happy about it and fought us tooth and nail.
    You'll like this one-we once told him that one of his visits wasn't a consult because it was a transfer of care. We told him to think of it as "Is this referring physician needing your advice on how to continue treatment with this patient, or does he know that you are the right person to take over care".
    You know what he said? (You'll love this) I'm a surgeon !!!! Every physician wants my opinion !!!!! HA!!!! We were floored. He made my coder cry. I was just ticked and went to my boss, the CFO with it. Apparently this physician was making many support staff in the clinic cry as he was just a jerk.

    My guess is that your situation is the same. You can either keep working for the jerk (and document that you disagree with his concept of coding) or you can find another place where the docs appreciate your expertise. I mean after all, what is he paying you for?

    I hope it gets better. At least you can laugh about it once you get past the anger.
    Last edited by cleanclaims; 09-23-2009 at 02:17 PM.

  5. #5
    Long Island/New York
    Thumbs down
    My advise to you would be to take your CPC credentials and work somewhere else. I know times are tough but you are clearly a very good coder. There are a lot of Dr's out there that are NUTS!! Being a guy I haven't had that pleasure and I know part of it is that I am a guy but there's still no reason for that CRAP! We've been hiring people here at my company and I see quite a few ads in the paper for coders/billers (I live in NY).

    But the stress of that type of enviorment will eventually get to you and unless they're paying you Derek Jeter-type of salary it's not worth it.

    Good luck!


  6. #6
    Milwaukee WI
    Default Who is your support?
    Who is YOUR support? Compliance officer? Adminsitrator? Manager? Department Chief?

    You say he is under scrutiny for a 97% error rate ... by whom? Is that person or group your ally?

    I think you have the right attitude. You definitely don't want to get into a p..sing contest with this guy.

    While it's a terrible way to have to do business, for now, keep your head down. If you can get some other "authority," whose expertise he does respect, to give the order that PAs must sign documentation (perhaps the head of hospital credentialing?) then do so.

    And polish up your resume; you may be looking for another job ... whether because he succeeds in trashing you or because you decide you've had enough. This guy is poison.

    Good luck.

    F Tessa Bartels, CPC, CEMC

  7. #7
    Phoenix, AZ
    Oh I'm so very sorry that you are dealing with this. I, too, have been there and done that! Long story short, we had a locum who thought he knew way more than he actually did. We documented, documented, documented (CYA)! Stick to your guns and as Rebecca previously stated, go to management. Take all of your documentation to them. You are a respected and loved member of the coding community!! Your management team should recognize what is going on. They know you!

    Hang in there! It's not fun but you will come out of this with your head held high AND with your ethics intact! You have our total support!!
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  8. #8
    Default Thank you so much for the support!
    The scrutiny is by the big dogs themselves, the OIG. I was brought in due to this, they wanted someone conservative and strict who would stand up and make sure medicare guidelines were followed. I don't work for the doctor, we are both employees of the hospital. I don't think he has the power to get them to fire me, and to be completely honest I think they would be in a very bad position if they did. That is flat up retaliation, he yells at me in front of a room full of people because he won't recognize CMS guidelines that I am enforcing.

    There is a scary/strange wind blowing where I work. They demoted the Chief Compliance Officer ( a very ethical and upstanding man who did an excellent job) and put in his place the former Materials Management Director, who has no compliance experience or background. The powers that be, ie the president, CFO, etc.. are all bowing down to this doctor because they don't want to lose the specialty, even though they are losing money and have opened the door for all kinds of trouble.

    I already left one job, after 9 years, because of the rampant fraud that was actually rewarded by them. So I am no stranger to doing the right thing, lol. I just hate to go thru that again. I want to fix it but I don't seem to be able to work with this guy.

    I thank you all so much for your support and advice, it is so wonderful to have people I can talk to. I will continue to practice CYA and pray it will get better. I hate to relocate since school just started but I will certainly look for other options. I feel very strongly about my job and responsiblities, I am responsible for keeping these providers on the straight and narrow. If I they won't let me do that, I certainly won't go down for them.

    It is very sad that they can't seem to see I am the one looking out for them, not the vendors who are bowing down to make them happy.

    Laura, CPC, CEMC

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