# Consult??



## cbunti (Nov 4, 2009)

I code part time for a surgeon and she will have students document her consult as well as dictate. She does sign his documentation and notes that she has examined the patient and agrees with his notes. (She does not document a chief complaint or physical exam herself). However, she does document her Impression and Medical Decision Making. I do not feel this meets the requirements for a consult as a teaching physician and have been coding it 99499 so she can receive some type of reimbursement. The person who enters the codes in the system refuses to enter the code because she does not agree. What is your advice?


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## saphire5 (Nov 4, 2009)

*Consult-student*

Refer to CMS Transmittal 1780.  It specifically states the student may only document the ROS and PFSH and must be performed in the physical presence of a resident or teaching physician.  All other documentation by the student is not applicable nor may it be countersigned or referenced as agreed with.  
Consults are one of the top 5 code groups identified by CMS's CERT program for highest error percentage.  (probable target for RAC) 
I would not recommend billing for these under any circumstance unless the physician is willing to perform their own documentation of the HPI, exam & MDM as well as dictating the consult letter. 
Hope that helps!


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## LLovett (Nov 4, 2009)

Consults can not be done as split shared under any circumstance. Students can not be billed for at all. Anyone can get the chief complaint, ROS, and PFSH so that could be ok, but the doctor has to validate the chief complaint (not restate it per se, just support it with the rest of the note), do the HPI, and do the exam in addition to the A&P.

Based on your description the only code I would be comfortable with is the 99499 as well. Don't know what your payer mix is but it looks like consults are going to become a thing of the past for CMS so that is something else you may want to mention to the provider when giving further education about billing for teaching services.

Good luck,

Laura, CPC, CEMC


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## FTessaBartels (Nov 4, 2009)

*Student Note = NO CHARGE*

We are a major teaching hospital. Notes documented by students are *NOT* charged at all. (We use a dummy code in our system to reconcile the date of service, but these are not sent to insurance.)

Students may take and document the ROS and PFSH but the teaching physician (or a qualified resident/fellow) must perform and document all the rest of the service.

I know ... how will the students learn if they never do the documentation?  And this is a huge "waste" of time for the surgeon to have to do this him/herself.  Too bad, so sad.  That's the rule. 

I would not even code the 99499.  If the teaching physician was present and performed the service, the TP will have to document it him/herself to get credit. 

It's a tough stance, but the only one that is absolutely defensible on audit.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## cbunti (Nov 5, 2009)

*consult??*

Thanks to everyone for your input.


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