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Consult code vs counseling patient

  1. #1
    Default Consult code vs counseling patient
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    I need an advise, one of the physician that I code, marked on ticket a consultation code to be bill, however record does not meet criteria for consult. What I noticed is that she is interpreting consultation visit as counseling base on the description on the CPT Book, and is including on the plan the time she spend counseling the patient. Please help me I have discuss this issue before with her, is there any black and white explanation somewhere so she can finally get this. Thanks a lot for your help
    Mildred Nieves, CPC

  2. #2
    Milwaukee WI
    Default Look at CPT guidelines
    Look at your CPT guidelines - can't get any more authoritative than that.

    A consultation is a request from a physician (or other qualified provider) to another physician for advice or opinion on the treatment/management of a patient problem/issue.

    Bear in mind that it is possible for a consultation to be requested, and for that consultation to be coded based on the time spent in counseling/coordination of care. This happens regularly in our Pediatric Surgery practice, when a pregnant woman's fetus is diagnosed in utero with a condition that will may require surgical intervention after the child is born. The OB/GYN will request a consultation from the Pediatric Surgeon on treatment options for the baby's condition. Mom comes in with copies of ultrasounds, etc and the Pediatric Surgeon spends 100% of the visit in counseling/coordination of care. It's still a consultation.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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