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Thread: Consultation vs Established patient

  1. #1

    Default Consultation vs Established patient

    AAPC: Back to School

    If a orthopedic does a consultation on a patient for shoulder pain and then 2 years later sees the patient again for hip pain, is the second one an established patient or consult? I know about the 3 year rule; however, I thought there was some kind of rule that says another consult can be billed if you are seeing the patient for a new problem. Thanks!!!

  2. #2
    Join Date
    Apr 2007
    Greeley, Colorado


    It can be a consult if it fits the criteria - request for opinion from another provider, render service, report back to requesting provider...
    Lisa Bledsoe, CPC, CPMA

  3. #3


    Is it another consult (the 3 R's are met) because it is a new problem?


  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default It could even be the SAME problem

    It could actually be the SAME problem and still be a consultation.

    If the requesting physician followed the consultants recommendations/advice on treatment/management of the original problem, but it is back and/or not responding, the requesting physician may ask for another consultation on the same problem from the same (or a different) consulting physician. It just depends on the actual scenario.

    Of course, if the patient is covered by Medicare you can no longer use the consultation codes at all.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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