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IP consult vs round

  1. #1
    Question IP consult vs round
    Medical Coding Books
    Hello everyone,
    Here is my question:
    If a patient is seen in the office for a cancer and it is determined that the patient has to be admitted for chemo because of other comorbidities, can that same physician bill for an IP consult? I think it should be a round, since we have established care for this patient, and there are orders that this patient will have to be admitted for several rounds of chemo.

    Any thoughts??
    Malama pono,

    Sundae Yomes
    CPC, CPMA, CEMC, CGIC, CGSC, CCS-P

  2. #2
    Default
    A consult has these things:
    1. A request for an opinion from the patient's current provider, which is documented in the record.
    2. The consulting physician's opinion/recommendations documented in the record.
    3. The consulting provider doesn't take over treatment.

    If your doctor has assumed care of the patient, then I'd report an inpatient visit, and not a consult.

  3. Default
    If their insurance still pays consults (hahaha!), bill the office visit as a consult if this was indeed a consult. Provided they were not admitted the same day.

    Also, if your doc is the admitting, he will use the initial care hospital codes with the new SI modifier.

  4. Default
    If their insurance still pays consults (hahaha!), bill the office visit as a consult if this was indeed a consult. Provided they were not admitted the same day.

    Also, if your doc is the admitting, he will use the initial care hospital codes with the new SI modifier. If they are admitted the same day as the office visit, same code and modifier.

  5. #5
    Default
    Isn't the correct modifier AI for the admitting/overseeing of care physician?

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