AAPC - Back to school
Results 1 to 5 of 5

Thread: Opinions on Amendments to "consult" notes

  1. #1
    Join Date
    Apr 2007

    Question Opinions on Amendments to "consult" notes

    AAPC: Back to School
    I find myself in yet another fun place with consults. I use this term loosely because the documentation does not meet the requirements for a consult. These services should have been billed as they were, which would have been subsequent care codes. The coding company did not do this, instead they hounded the providers until they amended their notes to show who the referring provider was. Referring in my opinion is the key word, as these were transfers of care not true consults. But of course I will get serious pushback for stating this is not a consult now since they feel they have met the requirements.

    Here is the question though. Can you add this type of info several weeks, months, nearly a year later in some cases and actually consider this a consult? If it was not documented originally who requested it how in the world could they have gotten a copy of the report? So in my mind we missed the requirement by more than just the name of the requestor.

    Thanks for your opinions or sources if there are any on this.

    Laura, CPC, CPMA, CEMC

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default I agree with you, Laura

    I'm with you on this one, Laura.

    There are a lot of reasons for needing the know the referring physician. Most of them have to do with managed care and requirements by the insurance companies for that information.

    Requesting a consult on a patient for a specific issue is another animal entirely.

    If I were running a coding company and I had a note that "might be" a consultation, I would ask the physcian to add the required information IF this was a consult. I would give the physician 3 days to comply, or I would code it as a new/existing/or subsequent hospital visit depending on the circumstances.

    Just a shot in the dark here, but I'm wondering if your coding company is being paid a percentage of charges? Consults are higher charges than other visits, hence a big incentive to code them whether appropriate or not.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    Tessa brings up an important point regarding the billing company's motivation. But you cannot do ammendments to a note once the claim has been submitted. Since the claim is suppose to be based on the documentation you cannot go back aftewords and start amending what was there.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Join Date
    Apr 2007

    Default Thanks for responding

    Thats the kicker Debra, none of these have ever been billed. They have held the billing until the notes were amended "to support" a consult.

    Strangely enough this company is not paid based on what we bill/collect. They get a flat rate each month. If you average it out most months they are getting about $70 per note, this includes no charge surgery follow-ups which are about 1/3 of the charges that come back from them each month.

    I am so on the wrong side of this deal....

    On the positive side administration has backed me on this one. They said the claims need to go based on what they were not what they have been changed to.

    Laura, CPC, CPMA, CEMC

  5. #5
    Join Date
    Apr 2007
    Greeley, Colorado

    Default I also agree

    Question: does the billing company have coders reviewing these notes and making these inappropriate recommendations? I would seriously question their integrity. Good luck to you Laura!
    Lisa Bledsoe, CPC, CPMA

Similar Threads

  1. """Looking for on Remote coding Possition""".
    By yeima26@yahoo.com in forum Resume Postings
    Replies: 2
    Last Post: 06-15-2014, 10:13 PM
  2. Injection "verbage" on notes/chart
    By CapeCodYankee in forum Orthopaedics
    Replies: 1
    Last Post: 01-20-2011, 01:03 PM
  3. Dx "codes" vs. "written" Dx's in notes
    By nolagirl in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-10-2010, 05:47 AM
  4. Trying to code "interstitial prominence" and "peribronchial thickening" using 2007
    By vazquecj in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 03-10-2010, 07:39 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.