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2nd time posting

  1. #1
    Default 2nd time posting
    Medical Coding Books
    If Dr. A referrs a patient to Dr. B. They both share an electronic medical record, and work for the same facility but is not in the same group. Dr. B did not state that the patient was referred by Dr. A, but gave all the other information that is needed, and at the end of the dictation, there was a notification that a CC went to Dr. A, and also the EMR has verification that Dr. A reviewed the dictation and signed off on it. Can you bill a consult for that scenerio?

    I am very familiar with what is needed for a consult, but these questions keep coming up, and I just want the verification that I am giving the physicians the absolute correct answer.

    Thank you in advance for your input, and appreciate any opinions that are out there.....
    Kristen Richard, CPC

  2. #2
    Greeley, Colorado
    First - was the patient referred for evaluation and treatment or was a consultation requested? I try to explain the difference between the words "referral" and "request for consult" to my providers, but it's really difficult to get it through to them - on both sides (the referring/requesting and the treating/consulting). As for your question, in my opinion, if Dr. B does not state in his documentation that Dr. A requested a consultation and why, then it is not a consultation. Even though they have a shared EMR, each encounter note must stand on it's own to support what is coded.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    The patient was referred for an evaluation to a new diagnosis. The patient was sent to us for an evaluation from the primary care physician. It's basically a second opinion to an abnormal finding, and because we are a multi-speciality Oncology group, we get alot of patients that are sent to us for these second opinions. Does that make a difference.

    So you are saying is that if it states that the pt is referred to us, and the note does not state that it is a request for consult, then it is not a consult? I do get confused with those 2 words, referral/request.

    Thank you for your input...
    Kristen Richard, CPC

  4. #4
    Greeley, Colorado
    If the PCP is requesting an opinion from your specialist, then that is a consult. BUT the specialist must document that he/she is being consulted by the PCP. The word referral has been a cause of confusion for many years. Request for consult is asking for an opinion, referral infers transfer of care for specific treatment. It sounds to me like your docs are doing consults based on the intent of the PCP wanting a second opinon, but educate them to document the consult request. My opinion - without that documentation, I would not code it as a consult.
    Lisa Bledsoe, CPC, CPMA

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