Wiki 2nd opinion post op

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deborahcook4040

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the scenario is, General Surgeon #1 sees a patient who was admitted through the Emergency Department. He performs an exploratory laparotomy with an excision of a pice of perforated bowel. The patient has many comorbidities, which are extending his recovery time fairly significantly. The patient is not happy with what he presumes to be a lack of post op care, and demands to see another surgeon. My surgeon is called in to consult on the patient's post op condition. He tells the patient essentially what the other doc had already told him - a perforated bowel takes a while to recover from.

Is this a billable consult, or should we count it as a favor toward the other surgeon and call it a day? If it is a billable consult, what diagnosis do I use? Abdominal pain? Oh, and this is a Medicare patient.
 
No consults for Medicare

Medicare does not recognize the consult codes, so that's out.

If the surgeon called in for the "2d opinion" is NOT in the same practice/same specialty as the operating surgeon, then Surgeon 2O can bill for his/her services. Choose the appropriate level E/M based on documentation. Remember NO consultation codes for Medicare patients.

If Surgeon 2O IS in the same practice/specialty as the operating surgeon, then this is part of the 90-day global period.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
Consultation

I do agree that Medicare does not recognize billing the consultation codes, but they do recognize that the work of a consultation can be billed.

As long as the consultation follows the CPT guidelines and all the requirements are met. The second surgeon could bill in the 99221-99223 range - per the Medicare crosswalk.

Billable work:
If the request is documented to be from a medical professional and not a family member or the patient himself. (see the CPT guidelines for who qualifies)

If the 3 R - requirements are met. For inpatient the report has to be in the chart only, not sent to the requesting physician.

3 R's of a Consultation:
1. Who Requested the consultation for an opinion?
2. Recommendations for treatment for the problem?
3. Report sent to requesting physician.

Consultations are not driving by new or established. A physician can consult on his own established patients.
 
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