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Opinions on Amendments to "consult" notes

  1. #1
    Question Opinions on Amendments to "consult" notes
    Clearnace Sale
    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
    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
    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
    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
    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

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