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Thread: Consults

  1. #1

    Default Consults

    AAPC: Back to School
    One of our physicians is asking a question that he is hearing conflicting information on so I wanted to send the question your way to see what you think. If an established patient of our office is admitted to the hospital and the admitting physician calls our doc in for a consultation for the same thing the patient is already established in our office for can we bill the consult?

    EX 1: a patient is admitted for chest pain and during their admittance it is determined that he has diarrhea and Crohns. Our office already treats this patient’s Crohns but the admitting physician has called us in for a consult. Can we bill the consult?

    EX 2: A patient is admitted for ______ and has Hepatitis C. The admitting physician calls in our doc for a consult for the Hep C however we already treat this patient. Can we bill the consult?

  2. #2
    Join Date
    Apr 2007
    Dallas, TX


    Inpatient care does not have to go by the new/established patient. You can code for the new consult and then subsequent after that.

    HOpe this helps,

    "Life isn't about waiting for the storm to pass...It's about learning to dance in the rain."

  3. #3
    Join Date
    Apr 2007

    Default Depends on intent

    Can you bill a consult for an established patient/problem, sometimes.

    If the requesting provider intends for your provider to take over management of this part of the patients care while they are in the hospital, no this is not a consult, it is a transfer of care.

    If the requesting provider is really just asking for an opinion on this and doesn't intend to turn over this part of the care, then this would be a consult.

    Intent used to be a CMS issue but with the update of CPT this year, intent is also a CPT issue.

    Laura, CPC, CPMA, CEMC

  4. #4
    Join Date
    Apr 2007


    I have heard conflicting information on this subject also. In the examples you give I do not think you are supposed to charge a consult. But again, I have never found anything definite. Interested in others comments on this subject.
    Susie Corrado, CPC
    ENT Coding/Billing

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