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Consults for Commerical Insurance

  1. #1
    Default Consults for Commerical Insurance
    Medical Coding Books
    Please help with this discussion. I have a Spine Specialist when he does a consult in his dictation he states Past Medical Hx: Has been reviewed and is signed in the patient's chart
    Past Surgical Hx: Has been reviewed and is signed in the patient's chart
    Family Hx: Has been reviewed and is signed in the patient's chart
    Social Hx: Has been reviewed ans is signed in the patient's chart
    ROS: has been reviewed and is signed in the patient's chart.
    When he states is signed he means the patient has signed the forms. My question is; Is this appropriate documentation for a Level 4 New Patient Consult?
    Thanks for your help

  2. #2
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    Quote Originally Posted by NESmith View Post
    Please help with this discussion. I have a Spine Specialist when he does a consult in his dictation he states Past Medical Hx: Has been reviewed and is signed in the patient's chart
    Past Surgical Hx: Has been reviewed and is signed in the patient's chart
    Family Hx: Has been reviewed and is signed in the patient's chart
    Social Hx: Has been reviewed ans is signed in the patient's chart
    ROS: has been reviewed and is signed in the patient's chart.
    When he states is signed he means the patient has signed the forms. My question is; Is this appropriate documentation for a Level 4 New Patient Consult?
    Thanks for your help
    The location of the information in the chart (ie, the date of service where it was taken) has to be indicated to use it on a later encounter. But yes, it is perfectly permissable to refer to ROS and PFSH recorded on a previous encounter.

  3. #3
    Default
    Thank You for your quick response but these have not been reviewed from a previous encounter, but the patient is a new patient to the provider and no one else has seen this patient in our facility, so does this still apply?

  4. #4
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    Quote Originally Posted by NESmith View Post
    Thank You for your quick response but these have not been reviewed from a previous encounter, but the patient is a new patient to the provider and no one else has seen this patient in our facility, so does this still apply?
    Did the patient fill out a questionnaire when they came in that covered their history? If so, and it's in the chart, then it's useful. If not, then you don't have any ROS or PFSH, so the highest level history you can obtain is PF. Hope that helps!

  5. #5
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    They did and Thanks again, but I have one more question, if you don't mind. Can the PA do the initial consult or must it be done by the provider. In this case the PA did the consult and never mentions that the provider was part of the visit. What do you think?

  6. #6
    Default
    Quote Originally Posted by NESmith View Post
    They did and Thanks again, but I have one more question, if you don't mind. Can the PA do the initial consult or must it be done by the provider. In this case the PA did the consult and never mentions that the provider was part of the visit. What do you think?
    Sorry it took me so long to answer - I didn't see your question until now...

    By definition, consults can only be performed by physicians. You must have all of these things to bill a consult:
    1. A documented request from a physician or other appropriate source (such as a PA, NP, doctor of chiropractic, physical therapist, occ. therapist, speech language pathologist, psychologist, social worker, attorney, or insurance company), for their professional opinion regarding the patient's diagnosis, or recommended treatment plan.
    2. An evaluation by the physician consultant.
    3. A documented written report (or reply) to the requesting provider/source, detailing their findings and recommendations.

    Only if you have ALL of those things, can you bill a consult. And as you already know, only commercial payers will cover it. Hope that helps!

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