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Consult vs New pt

  1. Question Consult vs New pt
    Medical Coding Books
    We have an issue that I was hoping to get some clarification on. Our office has an EMR system which has physician progress notes as well as a place in which the physicians can place referral requests. These requests can include testing as well as evaluate and treat. According to our policy, if a physician puts in a referral for 'evaluate and treat', this is considered a consult. If a physician puts in a referral for 'test', this is not considered a consult, of course.
    The question I have is if a physician has documented in his/her progress notes that they are referring for a test but in the referral it's noted 'evaluate and treat' (which, again, is considered a consult in our system) which do I go by; the referral or the physician's notes.
    A physician and fellow coder states it's ok to go by what is in the referral itself. One reason was if we were an outside office who didn't have access to the physician's notes, we wouldn't see what they had in their actual notes - only the referral. This physician also contacted some of the physicians who stated if they put in a referral for 'evaluate and treat' then they are asking for this physicians' opinion not only testing, no matter what is in their progress notes.
    So I'm left with the question of is this a consult or not???

  2. #2
    Milwaukee WI
    Default Change the wording of your options
    I would recommend you change the wording of your options.

    "Evaluate and advise" = consultation
    "Test and/or treat" = referral

    This makes it much more clear that what the originating physician is asking for is the consultant's advice or opinion on the management of the problem. (The physician who is being consulted MAY still initiate diagnostic testing or treatment for the condition being evaluated.)

    So if the PCP sees a patient who has fallen and injured her wrist, and notes on xray that the wrist is fractured, the PCP will send the patient to Ortho with a "test or treat" referral. The PCP doesn't really want Ortho to give the PCP advice on how to treat the broken wrist, he wants the Orthopaedist to treat the fracture.

    On the other hand, if the patient comes in with persistent knee pain, the PCP may send the patient to Ortho with a "evaluate and advise" request. The Orthopaedist may decide to order additional diagnostic tests, and may discover a torn meniscus that requires repair, but the original intent of the PCP to seek advice makes the first visit with the Orthopaedist a consultation.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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