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Thread: Surgical consult during OV

  1. #1
    Join Date
    Apr 2007
    Beaverton, OR

    Default Surgical consult during OV

    AAPC: Back to School
    Can someone tell me how you would code a surgical consult during an office visit. The surgery hasn't been schedule yet, provider and pt were just discussing the possible need for the surgery at some point, but there isn't a sense of urgency.
    Thanks for any help.

  2. #2
    Join Date
    Apr 2007
    Springfield, MO


    It depends on what kind of insurance the patient has and whether or not it recognizes consultation codes. MCR and many other insurances do not recognize them and then a new patient code would be used if your provider hasn't seen that patient in the last three years.

  3. #3
    Join Date
    Apr 2007


    If the patient was sent to the physician office for a consult from the primary physician then if it's not Medicare I would bill a consult visit. However if the patient is established and returned to the office for a follow up and they were discussing the possible need of surgery I would bill it as an office visit or a new patient office visit if it's not a follow up.

  4. #4
    Join Date
    Apr 2007
    Denver CO

    Default Surgery Consultation

    Don't forget to check with other private payers as to whether or not they still recognize the consultation codes. There is always the possibility that this visit could be billed based on time. If the majority of the visit involves counseling and/or coordination of care such as discussion regarding risks and benefits of the surgery or the provider is answering questions about the procedure itself, the visit could be coded based on face-to-face time. If this is the case, the provider would need to document the total amount of face-to-face time spent with the patient and then indicate that 50% or more of that total time was spent in counseling and/or coordination of care.


  5. #5
    Join Date
    Apr 2007
    Concord, NC or Rochester, NY


    This depends:

    1. If referred from another physician, then the consult code if the insurance accepts the codes, otherwise new/established patient based on the criteria.
    2. If it is your patient and the consult is not from another physician, then it is an OV which could be turned into a time based code based on the total time and >50% rule

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