# MFM Consults



## kjferg47 (Jul 24, 2009)

I have a question regarding MFM physicians billing consults.  Some of the MFMs I've been dealing with have regularly been billing high level consults but their documentation very often lacks a ROS and a many times has only a detailed Physical Exam at best!  When I approach them about this they all claim that the fetus is their patient, not necessarily the mother.  Can the exam of the fetus be considered as the physical exam to justify the consult?


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## Susan R (Jul 29, 2009)

*Maternal Fetal Medicine*



kjferg47 said:


> I have a question regarding MFM physicians billing consults.  Some of the MFMs I've been dealing with have regularly been billing high level consults but their documentation very often lacks a ROS and a many times has only a detailed Physical Exam at best!  When I approach them about this they all claim that the fetus is their patient, not necessarily the mother.  Can the exam of the fetus be considered as the physical exam to justify the consult?



I think I'd tell them they have to pick one patient or the other. How are they examing the fetus; by Ultrasound (US)? Then the physical exam of the fetus is included in the US; we can carve no separate E/M visit out of the US. 

One solution is to time base the visits; since a lot of the time, the *intent* of the consultation *is* counseling and coordination of care. 

MFM is one of my specialties as well; my doctors *usually *time base their consultations; making sure we are meeting the consultation components as well.

Good luck! 

Susan Reehill, CPC, CEMC


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## kjferg47 (Jul 31, 2009)

Thank you Susan.  By meeting the consultation requirements I assume you mean the "three Rs"?

Ken


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## LLovett (Jul 31, 2009)

I have a perinatal specialist as well.

All of her E/Ms are time based. The problem I run into with her is she usually does an ultrasound while she is with the patient. Her documentation says something like "I spent 40 minutes with the patient obtaining additional images and in counseling and coordinating care". Not cool. You can't count time doing the ultrasound toward your total E/M time since you are also getting reimbursed for doing the ultrasound. 

The other thing I have to watch is the consult issue. There may be a reason, recommendations and a report back but if there was no request (ie the patient made the decision to see her, not the OB), there is no consult. 

Just my 2 cents,

Laura, CPC, CEMC


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