# Is billing a consult correct for this scenario?



## 1073358 (Apr 10, 2008)

If a patient is admitted to the hospital for a heart condition and the patient has end stage renal failure and the cardiologist calls in the nephrologist, and the patient is a person who the nephrologist has already been treating on the outpatient side, is it appropriate for the nephr. to bill a consult if the request, reason, report criteria are met?


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## LOVE2CODE (Apr 11, 2008)

1073358 said:


> If a patient is admitted to the hospital for a heart condition and the patient has end stage renal failure and the cardiologist calls in the nephrologist, and the patient is a person who the nephrologist has already been treating on the outpatient side, is it appropriate for the nephr. to bill a consult if the request, reason, report criteria are met?



YES, Nephrologist can bill for a consult as long as he is not the admitting physician...

YTH,CPC


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## CC5657 (Apr 11, 2008)

I am so glad you asked that question. I work for a group of Nephrologists and we used to always bill for a consult in that situation. But, our office manager went to an RPA meeting last year & came back & told us that if an established ESRD patient is admitted for (say heart condition) & the nephrologist is asked to consult for Renal Management, then the nephrologist has to code that as a subsequent visit. Our docs are not real happy about this! Now, if the established patient is admitted to hospital for maybe sepsis due to infection in catheter, then the nephrologist, I beleive, can bill for a consult. It can get a little confusing, even for the doctors!! 
Let me know if you hear anything different.
Kathy, CPC-A


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## Belinda Frisch (Apr 11, 2008)

*Disagree*

I disagree with that scenario about the nephrology consult. I don't know if your manager misunderstood the speaker, or if they were given bad information.

I believe she is speaking on transfer of care, which is another situation altogether. If the nephrologist is NOT the admitting MD, he/she may bill for one consultation per hospitalization *if his/her advice or opinion is being sought.*
The 3 R's: request, render, and report are the only things required to bill a consult. 

http://www.aafp.org/fpm/20070300/45aref.html

Medicare's online provider manual (section 30.6.10) deals extensively with this topic:
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf


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