# consults vs office visits



## bmyers (Dec 18, 2012)

I recently just took over coding for a surgical group.  The issue we are having is consults.  If a patient is referred to us by a family physician who did the testing and found that the pt has gallstones.  Is this considered a consult  since we are taking over the care for this problem-cholecystectomy.  When I ck the cpt code book it says "If subsequent to the completion of a consult the consultant assumes responsibility for management of a portion or all of the pts conditions the appropriate E&M code for the site should be reported" I interpret that as saying this is not a consult.  Help me please.  My surgeons are not happy with me at this point.


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## dclark7 (Dec 18, 2012)

Try to explain it to them this way, a consult is a request for an opinion.  If the family physician did the testing and discovered tha gallstones, he already knows what the problem is and does not need an opinion, he is sending the patient for definitive treatment of the existing problem.


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## bmyers (Dec 18, 2012)

Thanks but as I am told they attended a seminar at a conference and they should be able to bill this as a consult.  He also sd that he isnt taking over care that he is taking care of the problem and sending the patient back to the family physician after the surgery.  I was going to remind him that the patient still has to come back to him for follow up care before being released back to the family physician.


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## mitchellde (Dec 18, 2012)

Lets go back to square one.  It is all dependent on what the family provider asked for.  Did he request your surgeon to examine the patient for gallstones and decide the appropriate method for treatment.. if so then no consult
or did the family care provide decide the patient had a problem of unknown nature that migh require surgery, and decide a surgeon should have a look and recommend the course of treatment... if so then consult.  
It is all based on what the family provider knew at the time of the request.


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## bmyers (Dec 18, 2012)

Pt just presented with 1 mo pain and she was seen by family physician who ordered testing and found out she had cholecystitis and cholelithiasis.  Then she was sent to us.


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## mitchellde (Dec 18, 2012)

Then it is not a consult.  The family provider knew the problem and decided a surgeon should evaluate for the possibility of surgery.. That is why the the book states when you decide to the treat the patient rot the reason they were sent to you it is not a consult.
If the patient had been sent to you for abd pain and your provider performed the testing then decided it was cholecystitis then it would be a consult.


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## bmyers (Dec 20, 2012)

Thank you Debra Mitchell.  That is exactly what I am pointing out to him.  Thanks for all your help everyone.


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## bmyers (Mar 1, 2013)

*consults*

Here we go again.  Now my physician is still stuck on this consult definition.  Could someone help me with documentation now.  He is really making it very difficult and I really want something in writing to present to him.  He says he should determine the code and that's it.


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## Twixle2002 (Mar 1, 2013)

Not to mention 90% of insurances will not pay for a consult code.  Medicare did away with the consult code due to over utilization and most insurances followed suit.  I know that the only one we charge a consult code to is BCBS.  This might also be something that you need to make your physcian aware of.


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## kvangoor (Mar 1, 2013)

BCBS does not accept consult codes any longer Twixle2002! Here is a good article I found on consults. Hope this helps your docs and you 
http://ahc.buffalo.edu/docs/Compliance-Consultation-Codes-Overview.pdf


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## bmyers (Mar 5, 2013)

*consults*

Thanks for the article.  Hopefully we can present this to him.  Everyone thank you again for  your response.


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## Twixle2002 (Mar 5, 2013)

thank you Kvangoor.  It helped very much.


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