AAPC - Back to school
Results 1 to 5 of 5

Thread: Consult??

  1. #1
    Join Date
    Apr 2007

    Default Consult??

    AAPC: Back to School
    I code part time for a surgeon and she will have students document her consult as well as dictate. She does sign his documentation and notes that she has examined the patient and agrees with his notes. (She does not document a chief complaint or physical exam herself). However, she does document her Impression and Medical Decision Making. I do not feel this meets the requirements for a consult as a teaching physician and have been coding it 99499 so she can receive some type of reimbursement. The person who enters the codes in the system refuses to enter the code because she does not agree. What is your advice?

  2. #2

    Default Consult-student

    Refer to CMS Transmittal 1780. It specifically states the student may only document the ROS and PFSH and must be performed in the physical presence of a resident or teaching physician. All other documentation by the student is not applicable nor may it be countersigned or referenced as agreed with.
    Consults are one of the top 5 code groups identified by CMS's CERT program for highest error percentage. (probable target for RAC)
    I would not recommend billing for these under any circumstance unless the physician is willing to perform their own documentation of the HPI, exam & MDM as well as dictating the consult letter.
    Hope that helps!

  3. #3
    Join Date
    Apr 2007


    Consults can not be done as split shared under any circumstance. Students can not be billed for at all. Anyone can get the chief complaint, ROS, and PFSH so that could be ok, but the doctor has to validate the chief complaint (not restate it per se, just support it with the rest of the note), do the HPI, and do the exam in addition to the A&P.

    Based on your description the only code I would be comfortable with is the 99499 as well. Don't know what your payer mix is but it looks like consults are going to become a thing of the past for CMS so that is something else you may want to mention to the provider when giving further education about billing for teaching services.

    Good luck,

    Laura, CPC, CEMC

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default Student Note = NO CHARGE

    We are a major teaching hospital. Notes documented by students are NOT charged at all. (We use a dummy code in our system to reconcile the date of service, but these are not sent to insurance.)

    Students may take and document the ROS and PFSH but the teaching physician (or a qualified resident/fellow) must perform and document all the rest of the service.

    I know ... how will the students learn if they never do the documentation? And this is a huge "waste" of time for the surgeon to have to do this him/herself. Too bad, so sad. That's the rule.

    I would not even code the 99499. If the teaching physician was present and performed the service, the TP will have to document it him/herself to get credit.

    It's a tough stance, but the only one that is absolutely defensible on audit.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Join Date
    Apr 2007

    Default consult??

    Thanks to everyone for your input.

Similar Threads

  1. ER Consult vs Inpatient Consult
    By lcouto in forum Emergency Department
    Replies: 1
    Last Post: 10-22-2015, 10:08 AM
  2. E/M OBV Consult converted to Inpt Consult
    By AmandaHartman in forum E/M
    Replies: 1
    Last Post: 06-13-2014, 10:36 AM
  3. Billing OV Consult vs Hospital Consult
    By crowemd in forum Auditing General Discussion
    Replies: 1
    Last Post: 02-20-2012, 02:02 PM
  4. IP consult
    By cchilva in forum E/M
    Replies: 3
    Last Post: 06-16-2009, 06:32 AM
  5. Replies: 1
    Last Post: 01-24-2008, 01:16 PM

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?


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.