Practice Management Alert

Question: Can we bill for an office consultation when we know at that visit that the patient will be returning to us for follow-up of the same problem? Should we have a form for the referring physician's approval for the consulting doctor to follow up so we can bill the follow-up care?

Maryland Subscriber  
Answer: If the patient is sent to your practice for treatment, code and bill for a new patient. If the patient comes to you at the request of another physician for an opinion or a consultation, code and bill a consult.
 
The physician seeking the consultation must give a clear request for a consult. After the consultation, if the consulting physician's opinion is that he or she should see this patient again to provide treatment, the physicians must communicate. The communication should state the consulting doctor's opinion that he or she should treat the patient, and should ask for the original physician's concurrence.
 
Practices often confuse consultations and referral for managed-care patients, who often arrive with a referral form that states "consult and treat." Such a form may also authorize a specific number of follow-up visits. Those cases are usually referrals, and when you see the patient for the first time, bill for a new-patient visit. Successive visits would be for an established patient. To avoid confusion, clarify when the patient makes the appointment whether it is a consultation for a physician's opinion only or a referral for treatment. If yours is a specialty practice, the extra step of contacting the original doctor and asking for a note that specifically states whether the patient is a consult for an opinion or a referral for treatment may help promote good relationships between your practice and primary-care physicians.  
-- You Be the Expert and Reader Questions answered by Jerry Haynes, MBA, CPA, administrator of the Pediatric Clinic, L.L.P, in Opelika, Ala.; and Catherine A. Brink, CMM, CPC, president of Healthcare Resource Management Inc. in Spring Lake, N.J.