Wiki Can a Consultation be billed if the referring was an ER doctor?

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I'm not sure about official guidelines, but our clinic has an internal policy that does not allow for consults to be billed when referred by an ER physician. The reasoning is that our provider sees the patient, works them up, and then provides a report back to the referring provider with their recommendations about treatment, testing, etc. that they feel is appropriate for the patient. The ER doctor is typically only involved in the patient's care in the emergency room setting and would not follow up with the patient on scheduling or treating the conditions based on the consultant's recommendations. This leaves the patient in limbo if he/she has no one to follow up with. We typically schedule and bill these as initial or established visits and assume care for these conditions.
 
Well said Amanda, I agree completely - the intent of a consultation is to get a specialist's input on the treatment plan. If the requesting provider is not going to continue overseeing the care, then it is simply a referral, not a consultation. I think the only time a consultation would be appropriate when requested by an ER physician would be if that service was actually performed in the ER itself, for example if the ER physician needed advice in order to decide if a patient should be discharged or admitted or transferred to another facility and requested a consultation to get the specialist's input.
 
Ed Consultations

Emergency Department physicians can refer patients for consultations. Large organizations often have multi-specialty services on site to provide consultation services within the confines of the Emergency Department. Additionally, if the services of both the ED physician and the Consulting Service share a medical record the CC back to the ED on the consulting service record would suffice as an appropriate response back to the ED provider. There are a multitude of organizations that have opted not to bill for consultations due to the Medicare guidelines of 2010.
 
Our group of Surgeons get consultation requests from ER doctors on a daily basis. Mostly for trauma patients whose injuries may require surgery.

If the patient does not require surgery we bill for the consultation with the ER doctor as the referring physician and we have never had a problem.
 
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