If the patient is referred to you for care of the problem he is an established patient.
If the PCP sent the patient to you with a request for your opinion on how the PCP should manage the problem, it is a consult.
If the patient is covered by MediCARE you cannot bill a consultation code in either case, because Medicare does not recognize the consultation codes.
If the patient is covered by MedicAID or commercial insurance you will need to check with the payer to see if they are following MediCARE rules on consultation codes. A few commercial carriers have announced they will also follow MediCARE re consults.
Hope that helps.
F Tessa Bartels, CPC, CEMC
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