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Thread: Consultation per admission

  1. #1

    Default Consultation per admission

    AAPC: Back to School
    Scenario 1-
    A patient is admitted to the hospital and a Specialty Physician is requested to consult on a specific problem. The patient is then discharged from the Hospital and readmitted the same day to another hospital. The Physician is then requested to consult again (different day from any other E/M services) for the same problem but different facility. Would a consultation be appropriate since this is a different facility even though the same problem is being treated? The physicain would not have continued treatment at the new hospital if not requested.

    Scenario 2-
    Same as above but the Specialty Physician had planned on treating the patient at the new facilty even though a new request for a consultation was documented.

    Scenario 3-
    Same as Scenario 1 except the hospitals. The first hospital is "Huron Hospital" and the second hospital is "Grace Huron Specialty Hospital" which is a floor in "Huron Hospital".

    Thank you!:

  2. #2
    Join Date
    Apr 2007


    Ok, scenario 1 doesn't sound like a true discharge but a transfer to another facility to continue the same admit. The CMS rule was one consult per provider per admit. CMS no longer covers consults and I am not aware of any commercial carriers having this rule (aside from the ones that follow CMS guidelines). So depending on the carrier you could have a 2nd consult in this case.

    The next issue is, is it really a consult or are they asking them to come manage this issue. It sounds to me like co-management in both scenarios 2 and 3 and possibly 1. In that case you don't have a consult at all but a transfer of care.

    Laura, CPC, CPMA, CEMC

  3. #3


    In the first scenario the patient was infact discharged and then due to complications went back to a different hospital for care.
    I am aware Medicare has eliminated payment for consultations however other insurances are still accepting them.
    The physicians in these scenario are not co-managing the issue they are giving their specialty opinion regarding one diagnosis (infections). They treat the one diagnosis and once that diagnosis is resloved the patient is discharged they will have no continuation of care.
    Does this change your answer at all??

  4. #4
    Join Date
    Apr 2007
    Carmel, New York

    Default One E/M per day per patient?

    Wouldn't this be a case of only assigning one E/M code by combining the services of the two visits?

  5. #5
    Join Date
    Apr 2007


    If they are being called in to treat an issue that is not a consult, that is a transfer of care.

    Consult is when the provider asks for another providers opinion/advice on how they should manage the issue. The intent is for the originating provider to handle it, not the specialist.

    In the 1st scenario I would hope this doesn't happen often and honestly I think from a payor perspective they will consider this a continuation of the original admit, not a new one. So my answer is still the same.

    As to MnTwins29 I was assuming (which you should never do) that these services were provided on different calendar days. If they were on the same date I agree they should be combined.

    Laura, CPC, CPMA, CEMC

  6. #6
    Join Date
    Apr 2007
    Carmel, New York

    Default Understandable...

    I took "same day" to mean the same day patient was admitted to first hospital. Was then d/c'ed and xfered on that same day, hence my question. Doncha just love the English language?

  7. #7


    As stated in the first scenario the EM's would be on different dates.

    To clearify the "transfer of care" problem...
    We are Infectious Disease specialists. We render only an opinion regarding what antibiotics would best suit the patients problem. We do not treat the problem only help the attending in regards to the care if it. Consult would be appropriate.

    Also there was no transfer to the other facility. The patient was discharged and sent home and on their own will went to a different facility and was admitted.

    Can someone please advise me on the questions asked??

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