Wiki Consult Codes/Documents

[bill2doc]

Do all consults need to have a request for a consultation, along with the need for a consultation, documented by the consultant in the patient's medical record and include in the patient's medical record of the requesting practitioner? Do we need the below also?:

?An opinion is rendered by the consulting practitioner. This opinion, along with any other service provided, is documented in the patient's health record.
?A written report of the consultant's findings and opinion or recommendation is communicated back to the requesting practitioner

*What about in the event that the patient, having a PPO, ability to go to any doctor without needing an auth or referral wants to get a consult from a specialist to obtain an opinion other than that of their PCP. Coming to us as a second opinion without a request for consult - Can we bill as consult?

Thank you
Lynn

 

[mhstrauss]

Do all consults need to have a request for a consultation, along with the need for a consultation, documented by the consultant in the patient's medical record and include in the patient's medical record of the requesting practitioner? Do we need the below also?:

?An opinion is rendered by the consulting practitioner. This opinion, along with any other service provided, is documented in the patient's health record.
?A written report of the consultant's findings and opinion or recommendation is communicated back to the requesting practitioner

*What about in the event that the patient, having a PPO, ability to go to any doctor without needing an auth or referral wants to get a consult from a specialist to obtain an opinion other than that of their PCP. Coming to us as a second opinion without a request for consult - Can we bill as consult?

Thank you
Lynn

The patient's chart must support all consult requirements in order to bill a consult. In the scenario you listed, it wouldn't meet the consult requirements; you would use the appropriate new patient (or established) code.

 

[CodingKing]

To add on to mhstrauss's comment. If you look in the CPT book the guidelines are specific (page 19 of 2015 AMA CPT Professional)

a "Consultation" initiated by a patient and/or family, and not requested by a physician or other appropriate source, is not reported using the consultation codes.