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Thread: Hospital Consultation Question

  1. #1

    Default Hospital Consultation Question

    AAPC: Back to School
    We have a patient that was admitted to the hospital by a different doctor and the admitting doctor ask my doctor for a consultation. Are we able to bill for the consultation even know it is our patient?


  2. #2


    First, I'm assuming the patient does not have Medicare (because, if so, you can't bill a consult anyway).

    If the problem you're being asked to give your opinion on is new to your physician, then yes, you can bill for a consult. If it is a problem you are already following and treating the patient for, then no, you can only bill for a subsequent visit.

    Lisi, CPC

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Consultations by PCP

    I disagree with Lisi's explanation.

    Makes no difference if you have been treating the patient for the problem.
    What is at issue is whether the admitting physician is asking you for your opinion on how the admitting physician will treat the problem during the hospitalization, or whether the admitting physician is asking you to take over the management of that problem during the hospitalization.

    So let's say your patient is admitted by orthopaedic surgeon for hip replacement. Your patient happens to be on medication for HTN. Surgeon asks for your opinion on how to manage HTN while patient in postop care.
    Even though you have been treating the patient for this condition, you can examine the patient and render an opinion on how the manage the HTN. You may not even need to see the patient again as long as the patient's BP remains stable. This is a consultation. (Whether you use the consult code or the initial hospital code depends on whether patient has Medicare.)

    BUT let's say the surgeon notes increased BP and asks you to come take care of the HTN while the patient is in the hospital. Now you are being asked to manage the case. This is NOT a consult.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4


    I would agree with what Tessa wrote. It just has to be clear what the admitting physician is asking -whether they want your opinion or want you to treat the problem.

    My answer came from my experience at our institution. I've seen my physician use the word "consult" on a patient he had been treating in the office. When I looked at the admitting MDs note, he was actually "notifying" my physician so he could continue to treat an on-going problem. The admitting MD did not want our opinion.


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