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Consults-I have a physician

  1. #1
    Default Consults-I have a physician
    Medical Coding Books
    I have a physician that documented in his consult note that he CC the referring physician his dictated note. I just need to know if that is sufficient documentation to be able to bill this visit as a consult? He did not state anywhere in the note that this patient was referred to him by the referring doctor.
    Kristen Richard, CPC

  2. #2
    North Carolina
    This isn't acceptable to me...

    My carriers guidance....

    Question: Would a ''CC:'' to the referring physician at the end of the consultant’s progress note be sufficient to satisfy consultation requirements?

    Answer: A “CC” at the end of the consultant’s note is the most minimal approach to providing a report back to the requesting physician. The consultant would be responsible in this case for clearly documenting in such a manner that the requesting physician can discern the expert opinion/plan the consultant is providing.

    We cannot verify that CERT or a Recovery Audit Contractor would accept this. A more direct and clear notation/brief letter would be better and should stand up to review by any and all parties.

    The cite for the report back to the requestor is from CMS Publication 100-4, the Medicare Claims Processing Manual, Ch 12, sect 30.6.10 which says: After the consultation is provided, the consultant shall prepare a written report of his/her findings and recommendations, which shall be provided to the referring physician.

    The manual does not prescribe a single or specific method of accomplishing this. As the carrier, we would expect to be able to see some notation that an appropriate "report" of some kind had been sent back to the requesting physician to complete the loop (i.e. support that the consultation requirements have been appropriately fulfilled). We'd find any simple statement to that effect satisfactory as long as there truly is a corresponding formal process to get the appropriate report back to the requesting physician (which a letter clearly seems to accomplish). Additionally, we would expect the consultation note to clearly address the issue for which the patient was referred. Finally, we would expect there is clear communication between the physicians to express the intent of the requesting doctor, i.e. is a consultation being requested or is care of a particular diagnosis the patient has being transferred to the second doctor (which should not be billed as a consultation but rather as a new patient visit).

  3. #3
    That definetly makes sense except: Let me explain:

    We are an Oncology group of physicians. In this particular case, the 2 physicians I am speaking of are in the same group under that same tax ID#. One doctor is a GYN Oncologist, and the other is a Medical Oncologist. The GYN Oncologist is the referring physician, and the Medical Oncologist is the physician providing the consult. Both physicians have access to the patients medical record in the office. They both work very closely together. That would be the only reason why I would accept a CC notation, due to these physicians are in the same practice. Thats why if this does not get billed as a consult, it would be an established patient. I probably should of been more specific, but I thought it would of been just a general question, instead of getting into depth. I appreciate your response. What is your thoughts on this scenerio???? I really want to give the credit for this consult, as that is what the physician dictated the note as. Can you feel my pain

    Thank you
    Kristen Richard, CPC

  4. #4
    North Carolina
    Since this is a shared record you'll probably be fine but as a precaution, check with your carrier to determine their "minimum requirements"

    The consultation service request may be written on a physician order form by the requestor in a shared medical record.

    In a large group practice, e.g., an academic department or a large multi-specialty group, in which there is often a shared medical record, it is acceptable to include the consultant’s report in the medical record documentation and not require a separate letter from the consulting physician or qualified NPP to the requesting physician or qualified NPP. The written request and the consultation evaluation, findings and recommendations shall be available in the consultation report.


  5. #5
    Thank you very much. Once again, you have been a big help...happy holidays
    Kristen Richard, CPC

  6. #6
    North Carolina
    Same to you!!

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