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Thread: Office Visit with surgery

  1. #1

    Default Office Visit with surgery

    AAPC: Back to School
    I work for a dermatology billing company and this is bothering me, I am not sure I am coding this correctly. Could someone give me some advise. I am not trying to jip the surgeon out of the money if it is due but there is a limit! Here is the situation:

    Patient is referred for a consult to a Mohs surgeon who does the consult and does the Mohs on the ear. He is billing for the consult and the Mohs. In steps the second surgeon ( Plastic surgeon) who now does the repair with a tissue flap. This surgeon also wants to charge a consult. Keep in mind that the patient was scheduled for the Mohs and the repair by the Doctors on the same day, in the same group.

    I felt that the only consult should go to the doctor who actually saw the patient and made the definite decision that a Mohs was necessary. Since the plastic surgeon was part of the group and had knowledge of the repair, even though she made the decision on what type of repair to do she is not entitled to a consult.

    Do you think I am correct. Please give me some thoughts so I can make a good argument for my decision. If I am not correct, I really need to get it straight in my head. This seems to be happening more and more and I would like to be consistant in my decision making.

    Thanks to all for any help you can give me.

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default NO consult

    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

  3. #3

    Default Thanks for the input

    Thanks F Tessa Bartels, I did leave somethings out but you got the "jist" of it. I appreciate your time and that is exactly how I feel. Thanks again.

  4. #4


    I work at an urgent care/family care facility. If a worker compensation patient comes in with a laceration to the arm and a simple repair is performed, no other dx, can an office visit also be billed? I was told it could be billed, but I don't feel this is correct. ANy help would be greatly appreciated.

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