# Consultations



## rcollins (Apr 21, 2009)

If a doctor dictates a separate letter, from his office documentation, does this support billing a consult? The office document only states who asked for the consult and the opinion from the consulting doctor.


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## FTessaBartels (Apr 21, 2009)

*Not sure I understand your question*

I'm sorry, I'm not really understanding your question.

Sending a letter to the patient's primary doctor in and of itself does not constitute a consult. (Our surgeons send notes to all the PMCs just to keep them apprised of what's going on with their patients, but not ALL these visits are consults.)

If you are asking whether a letter to the requesting physician suffices as a "report" back ... well it should indicate the nature of the problem (including some history), the findings of the consulting physician (his exam and any diagnostic tests/labs/xrays) and the consultant's recommendations. 

Your other office documentation would, of course, need to meet the requirements for documenting the level of consult (history, exam, MDM). But it would be fine for a cover letter to go to the requesting MD w/ a copy of the clinic note attached. 

Hope I answered your question. If not, please clarify your dilemma.

F Tessa Bartels, CPC, CEMC


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## rcollins (Apr 21, 2009)

Thank you for your reply. Yes I am asking if a letter to the requesting physician suffices as a "report" back.  In the letter the doctor only dictates, his findings, his dxs and what his recomendations are.  He does not put any of his exam or lab results or anything like that in there. He says that when the requesting docs see all that extra stuff, they are like what is he doing and trying to say. So our dr is short and sweet and to the point. 

His other documentation does meet the level of a consult, however it does not get sent with the letter. 

Does this help at all... I know there are 3 R's to a consult.  Request, Render and Report. The request and the render are in the providers office document, but the report is a separate document, do these 2 documents together suffice for billing a consult, providing the office document supports the level?


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## Karolina (Apr 22, 2009)

Once you have all Rs (Request, Reason, Recommendation and Report back) documented and the level is supported by the documentation and medical necessity then it is OK to send the report back with the recommendations on a separate document. Keep in mind if the code/charge is challanged to have both documents available to support your claim.


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## rcollins (Apr 22, 2009)

Is there a time limit on when the report back to the requesting provider has to be done?


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## Karolina (Apr 22, 2009)

I am not aware of a documented time limit, however keep in mind that this report is supposed to help the requesting provider in giving the best medical care to the patient. The report should be done within an appropriate timeframe to make sure the patient gets optimum care.


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## rcollins (Apr 22, 2009)

Ok, Thank you.  I think its going to be an internal problem.  We use an EMR and when we do our audits, we pull the documentation from the EMR, however the letters back to the requesting providers aren't always there when we pull our office visit documents.  So I have a hard time, stating it supports a consult.  We do our audits on the back in...

Thank you all who have helped me.... still


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## FTessaBartels (Apr 22, 2009)

*Time frame*

Our doctors dictate within 24 hours of the visit. The report is sent as soon as it is transcribed.

That's just good practice.  If a physician is asking for your opinion s/he probably needs it sooner rather than later. If the requesting physician isn't happy with your response time s/he will likely find a different consultant.

F Tessa Bartels, CPC, CEMC


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## Karolina (Apr 22, 2009)

If the report is done but not filed in the EMR it might be helpful to establish contact with the paper record staff or perhaps the administative assistants for the providers so that they may help you find the document before declining a consult that would otherwise be appropriate. That is - however - an internal issue.
Good luck!


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