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Thread: Visit before consult

  1. #1

    Default Visit before consult

    AAPC: Back to School
    Sometimes one of our doctors stops in briefly to see a patient that has been referred to him and then does an official consultation the next day. He wants to bill a visit for the brief visit and then bill a consultation for the second visit because that is when he dictates. and he sees the patient for the second time. I can't see any way of doing this because it would not make sense to the carriers. He is apparently doing it this way because he does not have the time to do a complete assessment on the first day I would think that we would either have to bill two visits or one consultation.

    Any thoughts?


    Last edited by medicalsec; 12-07-2010 at 03:47 PM. Reason: typo

  2. #2
    Join Date
    Apr 2007
    Lubbock, TX


    You're right - that doesn't make sense...Sounds like double dipping. Look at it from the payer's perspective. The doctor has been requested for a consult. He does a little bit of the work one day, then is too busy to finish for whatever reason. So he finishes the same work he started the day before, and now wants to get paid for 2 separate visits. Poor time management by the physician doesn't constitute liability on the insurer's part. As an analogy, let's say you have a maid that cleans your house, and gets paid by the day, regardless of how long it takes. She comes in and dusts a couple of pictures in one room, but then has to leave for the day. She comes back the next day and cleans everything else. Would you pay her twice?

    Also, how much work is really being done on the first visit? Is it just a little Q&A about their condition, or are they really performing elements that could constitute an E/M service? If they're just gathering some basic info, why couldn't someone from the ancillary staff handle it? I don't think that both visits will pay, for the simple fact that they're both covering the same issue, and there's no real reason the doctor can justify not taking care of everything at once.

    Just keep in mind, that you can only bill a consult for a true consultation, so be careful not to confuse consultations with transfers of care/referrals.

  3. #3


    Great answer! Thanks for the reply!


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