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Thread: New Patient Visit Vs Consult

  1. #1

    Question New Patient Visit Vs Consult

    AAPC: Back to School
    If a surgeon is seeing a new patient that was referred to him for surgery,
    can he bill this as a consult if he decides to make the decision for surgery on this patient? Or should this encounter be coded as a new patient?

    Any advice is greatly appreciated, and also are there guidelines for this situation listed out there for the doctors to review?

    Claudia K, CPC

  2. #2
    Join Date
    Apr 2007


    As long as the 3 R's were met the surgeon can bill for the consult if the decision was to go into immediate surgery use your -57 modifier.
    Kiana CPC, CPC-H, BCS-M, BCS-R

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Why was patient sent to surgeon?

    Claudia, you start your query: If a surgeon is seeing a new patient that was referred to him for surgery ...

    This sounds to me, as an auditor, as if the patient would be a NEW patient. The referring physician already knows what needs to be done, but he (the referring physician) doesn't do this procedure, so he sends the patient to a surgeon who does perform the necessary procedure.

    If, on the other hand, the primary physician sent the patient to the surgeon because he wanted the surgeon's opinion on the treatment of X condition, then you'd possibly have a consult ... even if the surgeon, after evaluating the patient, decided that surgery was warranted.

    F Tessa Bartels, CPC, CPC-E/M

  4. #4
    Join Date
    Apr 2007
    Greeley, Colorado


    I agree with FTessaBartels completely.
    Lisa Bledsoe, CPC, CPMA

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