Results 1 to 5 of 5

Dictating consult notes

  1. Question Dictating consult notes
    Exam Training Packages
    A question has been brought up from one of the Cardiothoracic surgeons that we just started handling their billing and he is asking how does he need to dictate a consult note if the patient has Medicare. Does he still dictate it as a consult even though we cannot bill it as a consult. He is worried about the documentation not matching up to the codes that are being billed. Please advise on how other practices are handling this. I hope this question makes sense.

    Thanks for any feed back.

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Dictate as a consult if you were asked for an opnion
    We instruct our physicians to dictate as a consult if they were asked for an opinion. We will code it based on the payer (i.e. use new or established outpatient, or ER, or inpatient codes). Our physicians don't usually know who the insurer is, and they don't need to worry about it.

    As long as the elements are there I can code the appropriate type/level of service no matter what format the documentation is in (including being in one long paragraph).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. Default
    Thank you so much for the information. I will pass it along to the physicians.

  4. Default E/M consult note ?
    Hello, for consult notes, phyisican must state the referring physician in the dictation? I have a note with no referring phyisican info but one of my physician coded it as a consult.

  5. #5
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by sechong11 View Post
    Hello, for consult notes, phyisican must state the referring physician in the dictation? I have a note with no referring phyisican info but one of my physician coded it as a consult.
    Send it back with a note about what is missing for a consultation and ask for the provider to either make an addendum to the original note or re-code the encounter.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

Similar Threads

  1. NP dictating for locums physician
    By MFox613 in forum Billing/Reimbursement
    Replies: 0
    Last Post: 04-24-2014, 07:51 AM
  2. re dictating of op note
    By paula f3 in forum Billing/Reimbursement
    Replies: 0
    Last Post: 10-26-2011, 01:03 PM
  3. PA dictating for MD; billing under MD
    By valleycoder in forum E/M
    Replies: 3
    Last Post: 09-24-2010, 11:44 AM
  4. Replies: 4
    Last Post: 01-25-2010, 08:26 AM

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?

Login

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.