Results 1 to 4 of 4

Is billing a consult correct for this scenario?

  1. #1
    Default Is billing a consult correct for this scenario?
    Medical Coding Books
    If a patient is admitted to the hospital for a heart condition and the patient has end stage renal failure and the cardiologist calls in the nephrologist, and the patient is a person who the nephrologist has already been treating on the outpatient side, is it appropriate for the nephr. to bill a consult if the request, reason, report criteria are met?

  2. #2
    Smile
    Quote Originally Posted by 1073358 View Post
    If a patient is admitted to the hospital for a heart condition and the patient has end stage renal failure and the cardiologist calls in the nephrologist, and the patient is a person who the nephrologist has already been treating on the outpatient side, is it appropriate for the nephr. to bill a consult if the request, reason, report criteria are met?
    YES, Nephrologist can bill for a consult as long as he is not the admitting physician...

    YTH,CPC

  3. #3
    Default
    I am so glad you asked that question. I work for a group of Nephrologists and we used to always bill for a consult in that situation. But, our office manager went to an RPA meeting last year & came back & told us that if an established ESRD patient is admitted for (say heart condition) & the nephrologist is asked to consult for Renal Management, then the nephrologist has to code that as a subsequent visit. Our docs are not real happy about this! Now, if the established patient is admitted to hospital for maybe sepsis due to infection in catheter, then the nephrologist, I beleive, can bill for a consult. It can get a little confusing, even for the doctors!!
    Let me know if you hear anything different.
    Kathy, CPC-A

  4. #4
    Default Disagree
    I disagree with that scenario about the nephrology consult. I don't know if your manager misunderstood the speaker, or if they were given bad information.

    I believe she is speaking on transfer of care, which is another situation altogether. If the nephrologist is NOT the admitting MD, he/she may bill for one consultation per hospitalization if his/her advice or opinion is being sought.
    The 3 R's: request, render, and report are the only things required to bill a consult.

    http://www.aafp.org/fpm/20070300/45aref.html

    Medicare's online provider manual (section 30.6.10) deals extensively with this topic:
    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

Similar Threads

  1. RE: Is this coding scenario correct?
    By Kar116 in forum Pediatrics
    Replies: 2
    Last Post: 05-22-2014, 08:03 AM
  2. Correct billing?
    By ollielooya in forum E/M
    Replies: 1
    Last Post: 01-18-2014, 07:38 PM
  3. Billing OV Consult vs Hospital Consult
    By crowemd in forum Auditing General Discussion
    Replies: 1
    Last Post: 02-20-2012, 03:02 PM
  4. Replies: 2
    Last Post: 02-01-2010, 07:05 PM
  5. What is the correct billing?...
    By cbrice in forum Family Practice
    Replies: 1
    Last Post: 12-31-2008, 02:45 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.