If I am reading your post right, there is NO consult here at all. A consultation is a request for advice or opinion on the management of a condition. If the patient is being sent to you for definitive treatment of an already known condition it is not a consultation, it is a transfer of care.
Here's what I think is happening: (Please correct me if I am wrong.)
Patient is sent to Dr Mohs to have the Mohs surgery done. Dr Mohs wants to bill a consultation and the Mohs procedure all on same day of service.
As a result of the Mohs procedure Dr Plastic is called in to do a tissue flap repair of the surgical site. Again, this is all during the same operative session. And all these services were scheduled to occur in advance.
If I have the above correct, there is NO consult at all. Dr Mohs has a new patient visit with decision for surgery, and the Mohs procedure. Dr Plastic has the advancement flap repair. OR Dr Plastic has the new patient visit w/ decision for surgery and the advancement flap; while Dr Mohs just has the Mohs surgery.
The Mohs surgery has a -0- global period, but the flap has a 90-day global. I'd have to see the documentation to see who actually evaluated the patient ... if Dr Plastic didn't come face-to-face with the patient until the patient was already under anesthesia Dr Plastic can't have performed all the elements of a consultation (or any other E/M for that matter).
Hope that helps.
F Tessa Bartels, CPC, CEMC
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