# Consults



## LLovett (Aug 17, 2009)

I'm getting ready to fight an uphill battle and I would love to have some opinions before I do. 

I see some of the stuff they try to bill as consults and think no wonder CMS plans on no longer paying for them.

Example #1

REASON FOR CONSULTATION:  Possible coronary artery bypass surgery
     candidate

To me, this is pretty clearly a transfer of care. The cardiologist that did the cath which showed the 90% blockage sent the patient to one of my CVT surgeons. The above is from the "consult" note. The documentation supports a level 3 consult or a level 1 admit. I think this should be an admit, the cath was done outpatient, CVT sees patient they go inpatient and have surgery 3 days later.

Example # 2

REASON FOR CONSULTATION:  Loculated pleural effusion with
     possible trapped lung. We were consulted for possible
     decortication.

Again, seems pretty clear this is a transfer of care. My favorite part about this one is there is no requesting provider listed. He does end the note with a thank you for the consult but I have no idea who he is thanking. The referring physician listed for billing isn't even one that saw the patient during this admit and is not his regular physician.

These were not coded by the surgeons, they were coded by an outside company. I have huge stacks of errors this company has made and continues to make. I have finally been able put a billing hold on all coding done by them, but I don't know how long that will last.

I am continually showing them these types of errors and the powers that be won't cut them loose. I guess I just wanted to get others opinions, am I being unreasonable or is this as bad as I think it is? This practice is about 85% medicare patients.

Thanks for any opinions or advice,

Laura, CPC, CEMC


----------



## ARCPC9491 (Aug 17, 2009)

Laura, I'm like you. I totally agree with what you are saying.

Last week in my conference, the speaker said during another one of her presentations, primary care physicians sat on one side of the room and specialists on the other. The specialists were arguing about how "every time they get a new patient, it is a consult, just because they are specialists" 

A primary care physician, stood up in a rage, and stated "Look, in the 15 years that I have been "REFERRING" my patients to you, less than 5% have ever been consults. I don't want your advice or opinion, I know what is wrong with the patient, but I can't treat it so that's why I send them to you, for you to take care of. and those AREN'T CONSULTS. And with that I said, I am sick and tired of receiving your "dictations" that say, "Oh, thank you so much for asking me for my advice and opinion on Mrs. Jones, my opinion is as follows." That's a play on words and you are doing that to get paid and it isn't fair to us primary care physicians who work harder than you "specialists"!!! "

Needless to say, she was NOT a happy camper.... but you know what, I totally agree with her. I definitely feel as if specialists are totally over paid. The primary cares are doing all of the work, treating all of these patient's problems and managing every aspect of it. The specialists treat that "problem" and back to the PCP they go. Primary cares do just as much work -- if not more -- than specialists. 

What we have to remember is every physician learned the same fundamentals of medicine -- some of those physicians chose to practice a speciality. I believe it is fair to say, that all physicians have the baseline knowledge of a primary care physician and with that said, backs up the argument that 9 times out of 10, the primary care physician knows exactly what is wrong with the patient -- and they are transfering care to that specialist who can take care of it. End result? No consult!

Taking away the consult codes would do two things, rightfully pay the primary cares and make this a heck of a lot easier for coders.


----------



## LLovett (Aug 17, 2009)

I wish I could have seen that! Good for her.

Thanks!

Laura, CPC, CEMC


----------



## FTessaBartels (Aug 17, 2009)

*Not consults*

I agree with Laura and Ashleigh ... these are not consults.

But I do have a question about the future of consult codes ... what is going to happen when the surgeon sends the patient to his/her PCP for the H&P?
Right now they frequently call it a consult, saying they (the surgeons) need information on management of chronic issues.  But there will be no medical reason for the PCP to see the patient ... "clearance for surgery" isn't a medically necessary reason for an E/M.

It seems to me that most surgeons are just being lazy and not doing the work they are being paid to do .... the admission E/M is included in the RVUs for the surgery and should be performed by the surgeon. (MY surgeons do all their own H&Ps.)

Okay ... off my soap box, now. 

F Tessa Bartels, CPC, CEMC


----------



## Lisa Bledsoe (Aug 17, 2009)

I applaud the PCP with a standing ovation!!  

Question for you all:  is it CMS or the AMA (or both) that is considering doing away with consultation codes?  I want my facts straight when I talk to one of my "specialists" (a surgeon) about this issue.

Thanks!!


----------



## LOUISE SLACK (Aug 17, 2009)

I would also like to see consultation codes go away but then there is the small group of specialists that truly perform consultations and do not follow the patients.  They can spend an hour with a patient/family and return the patient to the PCP to continue to follow. Sometimes it really is a request for opinion/advice.

Does anyone know when we will get the decision on the proposal?
Thanks


----------



## LLovett (Aug 18, 2009)

*2010 Proposed rule from CMS*

Right now it is CMS that is saying they plan to stop payment on consult codes, but as I have told the providers here CMS usually leads the pack and everyone else will more than likely follow right behind them.

We have until 8/31/09 to submit comments to CMS and they will announce the final rule on 11/1/09 effective 1/1/10 unless otherwise stated.

http://www.cms.hhs.gov/apps/media/p...ge=&showAll=&pYear=&year=&desc=&cboOrder=date

Laura, CPC, CEMC


----------



## ARCPC9491 (Aug 18, 2009)

Right, it is CMS. I'm not sure what the AMA's stance is ... I'll try to dig around.


----------



## LOVE2CODE (Aug 18, 2009)

ARCPC9491 said:


> Laura, I'm like you. I totally agree with what you are saying.
> 
> Last week in my conference, the speaker said during another one of her presentations, primary care physicians sat on one side of the room and specialists on the other. The specialists were arguing about how "every time they get a new patient, it is a consult, just because they are specialists"
> 
> ...



wow....that was a good conference to attend....


----------

