Results 1 to 2 of 2

Consultation auditing help, please

  1. Exclamation Consultation auditing help, please
    Medical Coding Books
    I have a different understanding and interpretation than my coworkers on billing consults in the hospital setting. They believe that as long as someone like a hospitalist or a primary care doctor has admitted patient and writes an order, it is a consult. It does not matter how many times or how recent our specialist has seen the patient prior. I have been searching for documentation but I cannot find anything clear about consulting on established patient. They are meeting the three "R"s but this seems wrong. They claim that the hospitalist is the admitting and they are only a consultant in the hospital for most patients and are documenting in that manner. We all are looking at the same policies from Medicare and seeing different things. If you Google the phrase "Widespread Probe Review Results of Consultation Services" it is showing most consults audits are failing by well more than half. So there must be significant confusion.
    I was taught that unless the patient has an unrelated problem than it is not a consult, but of course primary care can do a consult on their patient prior to surgery?
    They are meeting all the requirements from CMS. They have the hospitalist admit their patient, and request the consult. They are technically following the rules. Their dictation is solid and through. My issue with these consults is I believe they should be charged as transfer of care. They are already are treating the patient for the same diagnosis in the clinic. So for example patient is receiving chemotherapy treatment then two days later the patient is dehydrated. The patient presents to ER and is admitted. The hospitalist requests the patient's oncologist to see the patient. The requirements are met, but it seems wrong. We are looking at the guidelines from CMS and the providers are saying they are doing what is required. I say it is a transfer of care but they are reading you can still do consult and provide treatment if needed. Some doctors are providing several consults a month on the same patient same problem but different requesting. I cannot find anything to support my opinion and they are open to what I am saying if I can prove it.
    Thanks for any help.

  2. #2
    Greeley, Colorado
    You are absolutely correct. Unless they are being consulted on a new/different diagnosis, they cannot code a consult. If they routinely address the same problems in the office, it is NOT a consultation. The only deviation from this is the consultation prior to surgery because the surgeon is requesting the provider's opinion as to whether or not the patient is stable enough to udergo surgery.

Similar Threads

  1. E/M vs Consultation
    By adooley in forum E/M
    Replies: 11
    Last Post: 04-16-2014, 09:51 AM
  2. consultation/E/M Help :)
    By BABS37 in forum E/M
    Replies: 6
    Last Post: 01-24-2012, 07:51 AM
  3. Need Consultation Help
    By aeacpc35 in forum E/M
    Replies: 3
    Last Post: 09-06-2011, 08:34 AM
  4. Outside Consultation - Help....
    By HNISHA in forum Pathology & Clinical Laboratory
    Replies: 3
    Last Post: 02-25-2010, 11:30 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.