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E & m consult billing

  1. Default E & m consult billing
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    Hello:

    I have a question in regards to billing for a Consult. A physician where I work is billing for Consults on patients who are self referred. He stated that as long as he writes a letter to the patients PCP, he is allowed to bill for Consults. I tend to disagree but since I am not a coder I want to check with my resources....

    Thank you so much and have a great day!!!!
    Lori

  2. #2
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    Quote Originally Posted by COSITACHULA920@HOTMAIL.COM View Post
    Hello:

    I have a question in regards to billing for a Consult. A physician where I work is billing for Consults on patients who are self referred. He stated that as long as he writes a letter to the patients PCP, he is allowed to bill for Consults. I tend to disagree but since I am not a coder I want to check with my resources....

    Thank you so much and have a great day!!!!
    Lori
    Your thinking is correct! Self referred is equavilent to new pt not a consult. There must be a written request from another physician, just because your doc is going to send a letter to the PCP that does not constitute a consult.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  3. Default
    Thank you soooooo much Roxanne!!!!!!

    Have a great day!!!!!

  4. #4
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    I would refer your provider to CPT's definition of a consultation. Your provider must receive a request for a consultation, render his opinion and report his findings back to the requesting physician. While sending a report back to the PCP may be good continuity of care, it does not meet the definition nor the requirements to report a consultation code.

    Consultations
    A consultation is a type of evaluation and management service provided by a physician at the request of another physician or appropriate source to either recommend care for a specific condition or problem or to determine whether to accept responsibility for ongoing management of the patient's entire care or for the care of a specific condition or problem.

    The written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source. The consultant's opinion and any services that were ordered or performed must also be documented in the patient's medical record and communicated by written report to the requesting physician or other appropriate source.

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