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New Patient Visit Vs Consult

  1. #1
    Question New Patient Visit Vs Consult
    Medical Coding Books
    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
    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
    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
    Greeley, Colorado
    I agree with FTessaBartels completely.
    Lisa Bledsoe, CPC, CPMA

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