Now, when you say it's a consult, that means there is a "request for advice or opinion" in place. I've worked in bariatrics and most patients do not fit that bill. Most are self-referred for weight loss and there is no consultative nature to their visits.
To address the coding based on time issue that is for when "counseling and coordination of care dominates more than 50% of the encounter" ONLY. To bill for services meeting that criteria the MD must document total time spent, total time spent counseling (to demonstrate the 50%) and summarize the content of the counseling (to be safe).
A ROS on a patient presenting for any kind of surgery is just good medicine. In the case of a lap band patient, there are things that should definitely be reviewed not the least of which is constitutional (weight changes), musculoskeletal (weight bearing joint issues) and psychiatric (as at least some of these patients will need psych clearance prior to being approved by insurance for this surgery). From a medical necessity standpoint, you're going to want good documentation in order to get appeal should you not get paid. Bariatrics is particularly tricky.
Hope this helps clear things up.
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