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Consultation or Not ?

  1. Default Consultation or Not ?
    Medical Coding Books
    Our practice is trying to get some clarification on consults. My co workers and I have come up with several scenarios that are most common with or practice and would like your help... please read on.... thanks

    Scenario

    Established pt with our practice with known DM is admitted by surgeon for procedure. Post-op
    DM is found to be elevated. Surgeon request consult from PCP regarding DM management.
    PCP writes orders for change in meds. Several days later pt is worse and PCP is at this time asked to assume management of DM

    Q: Is initial visit still considered a consult?

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default It might be ...
    You have
    1) request for opnion
    2) reason for request - guidance on DM management
    3) report - ?
    You state that PCP wrote orders for changes to meds. Did the PCP write (or dictate) a consult report in the patient's chart? Our hospital provides "consult forms" that physicians can complete, which help to clearly differentiate a consult from a progress note. But any written communication will do, as long as the PCP indicated this was a consult requested by surgeon for advice on management of DM and he then included the necessary bullet points for the 9925x.

    When the PCP takes over management several days later, those visits are subsequent hospital visits.

    F Tessa Bartels, CPC, CPC-E/M

  3. #3
    Default Consultation Coding
    I agree.

    You have the request, the rendering of care , and likely the report--fulfilled by documentation in a common inpatient record. The physician later assuming care does not negate the initial consult.

    Here's a great article, hope it helps:
    http://www.aafp.org/fpm/20070300/45aref.html


    Quote Originally Posted by lljenkins View Post
    Our practice is trying to get some clarification on consults. My co workers and I have come up with several scenarios that are most common with or practice and would like your help... please read on.... thanks

    Scenario

    Established pt with our practice with known DM is admitted by surgeon for procedure. Post-op
    DM is found to be elevated. Surgeon request consult from PCP regarding DM management.
    PCP writes orders for change in meds. Several days later pt is worse and PCP is at this time asked to assume management of DM

    Q: Is initial visit still considered a consult?

  4. #4
    Default
    No I do not see this first visit as a "consult". The surgeon does not want an "opinon". he wants your guy to "handle" he is transferring care.....the DM problem. This should be looked at as "concurrent care" and not consult. your phyisician will be billing out regular subsequent hospital care codes . i see this as transfer of care for DM. Even with the first visit.

  5. Default
    I disagree, because the surgeon was not requesting the PCP's opinion. He was requesting that the PCP "manage the DM". The intent of the visit was for the PCP to handle the DM. A consultation is a request for an opinion from one provider to another. Typically it would be a "specialist" that is being asked for there opinion because they have expertise such as Ortho, Endo, Cardio, Neuro ect ect.

  6. #6
    Location
    Milwaukee WI
    Posts
    4,466
    Default CONSULT requested
    Allison & Tammy ...
    The first visit the surgeon is requesting "consult from PCP regarding DM management"

    The surgeon is NOT requesting that the PCP manage the DM, but is asking for an opinion on how to manage the DM. Many surgeons can handle a chronic condition for a day or two with some guidance, and if the patient's condition remains stable.

    On the other hand, the second visit, the surgeon is definitely asking the PCP to take over management because the patient's DM has worsened. So a subsequent hospital visit would be the appropriate code for the second (and any additional) visit.

    F Tessa Bartels, CPC, CPC-E/M

  7. #7
    Thumbs down
    Established pt with our practice with known DM is admitted by surgeon for procedure. Post-op
    DM is found to be elevated. Surgeon request consult from PCP regarding DM management.
    PCP writes orders for change in meds. Several days later pt is worse and PCP is at this time asked to assume management of DM.


    No consult to me - From what you have provided, the PCP changed the meds, and took care of the problem or at least what was thought to take care of the problem - for DM patients, thats what management typically is - changing meds. esp if it's elevated. the patient is known to the PCP, the PCP manages the problem, the surgeon called the PCP to fix the problem. No consult. I realize that the surgeon may have used the term "consult" and I realize a surgeon may be able to handle the problem for a day or two... but how often does that actually happen? none of my surgeons do at least.

    Several days later ............. still no consult, use subsequent care codes if inpatient, established codes if outpatient.

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