# To code a consult or New Pt



## twosmek (May 13, 2009)

My office is in an uproar as well, We are an orthopedic specialty clinic. Most if not all of our new pt are referral from a PCP in our hospital system. We have the request for a referral/consult depending on the MD whether it is in the visit dictated note or in an official request. The ortho MD does send a copy of thier visit to the referring MN and most time assumes the care of that problem. I am also now asking what the intent is from the PCP and get Eval & treat almost everytime. I will list some scenerios and please help me decided which ones should be consults and which ones New pt/est pt.

#1 PCP sees pt for annual physical, pt states that they have had knee pain for 2 yrs. PCP tells the pt that they should be seen by orthopedics and sets up the appt. The pt is seen here xrays are ordered and viewed. Orthopedic MD decides that a MRI is needed and schedules the MRI and an appt for the pt to come back to review the result. A copy of the dictated note is CCed to the PCP.
Consult or New/Est Pt

#2 PCP has been seeing pt for shoulder pain for 6 months has had MRI and xrays taken. PCP decides that there is nothing more he can do and tells pt to see an orthopedic MD. Sends a request to orthopedics to schedule an appt. Pt is seen and it is determined that she needs an arthroscopy, surgery is scheduled and pt will f/u with orthopedic MD. Orthopedic CC's PCP on note.
Consult or New/Est Pt

#3 PCP decided that pt needs a steroid injection into a shoulder joint. PCP sends referal to orthopedic MD for injection. Orthopedic MD has xrays taken and then does an injection and tells pt to follow up in 2 weeks with orthopedics. Orthopedic MD sends copy of note to PCP.
Consult or New/Est Pt

#4 PCP sees pt for shoulder pain, has already had xrays and MRI ordered by PCP. PCP determines the PT needs a rotator cuff repair, tells pt he needs to have an orthopedic MD do the surgery. PCP sends referral to Orthopedic to evaluate for rotator cuff repair. Orthopedic MD sees patient and does schedule Rotator cuff repair and pt will follow up with Orthopedic MN. CCs note to PCP.
Consult or New/Est PT.

Thoughts??


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## RebeccaWoodward* (May 13, 2009)

We went through the same type of questions and scenarios within our Orthopedic practice.  This can become a grey area at times, however, here's my 2 cents.

Scenario 1 and 2 (knee pain and shoulder pain) are somewhat broad symptoms.  If the intent of the PCP was to seek an opinion from your Orthopedic providers, I would consider these consults. But again, it really falls on the intent of the PCP's intent and how the PCP documents and conveys this information to your practice.

Scenario 3 and 4.  These scenarios seem a little more clearer as to what the patient's plan of treatment should be. It appears that the PCP has established what the problem is and is simply asking the Orthopedic provider to render the treatment...transfer of care=New patient (assuming their new).  Again...I'm making an assumption that the PCP has established the plan of care and conveyed to your office that they are requesting managment of care.

I can't emphasize enough the intent of the request.  There should be clear communication, either way.  I'm not in favor of verbal communication from a PCP to a specialist.  I prefer to see it in writing...by way of a form, as an example (transfer of care versus consultation) so that nothing is left unsaid or unturned.


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## rthames052006 (May 14, 2009)

twosmek said:


> My office is in an uproar as well, We are an orthopedic specialty clinic. Most if not all of our new pt are referral from a PCP in our hospital system. We have the request for a referral/consult depending on the MD whether it is in the visit dictated note or in an official request. The ortho MD does send a copy of thier visit to the referring MN and most time assumes the care of that problem. I am also now asking what the intent is from the PCP and get Eval & treat almost everytime. I will list some scenerios and please help me decided which ones should be consults and which ones New pt/est pt.
> 
> #1 PCP sees pt for annual physical, pt states that they have had knee pain for 2 yrs. PCP tells the pt that they should be seen by orthopedics and sets up the appt. The pt is seen here xrays are ordered and viewed. Orthopedic MD decides that a MRI is needed and schedules the MRI and an appt for the pt to come back to review the result. A copy of the dictated note is CCed to the PCP.
> Consult or New/Est Pt
> ...




I agree with Rebecca on all cases except #2 maybe I'm assuming to much ( which could be the case) I just think since the PCP feels there is nothing more he can do he is "transferring" the care to the Ortho, I guess it could  be a consult and treat type issue also. As Rebecca said it depends on the intent of the referring physician.  But I feel that because this type of dx it would be in the scope of the Ortho is why I say it would be a transfer of care.

Also if the Ortho is going to be doing surgery on this shoulder, if surgery resolves the issue it would be a non existing problem anymore, but lets say pt still has some issues months after surgery he would be contacting the ortho.


Just my opinion.


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