Wiki Consult in ED

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lhoot

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Good morning,
When counting data for E/M in the ED, would a request for a consult be considered "Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported)"?
Thank you,
Laura Hoot
 
per Noridian:

Q22. Where can we include the referral, under risk or data and how can we use that?
A22. A referral could fall under risk depending on the documentation and decision process. Discussion of management could fall under data. Example: If referring a patient for major surgery that could be high risk. If you are referring for minor surgery that could be a lower risk. This will all depend on the situation and what the risk to the patient is.
 
Good information to have, but this instance is for a consult and not a referral. The ED physician is needing the expert opinion of a neurology consult. The ED physician, in this case, is not deferring the care of the patient to the neurologist, so I'm not so sure the Noridian guidance quite applies.
 
lhoot said:
Good information to have, but this instance is for a consult and not a referral. The ED physician is needing the expert opinion of a neurology consult. The ED physician, in this case, is not deferring the care of the patient to the neurologist, so I'm not so sure the Noridian guidance quite applies.
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that sounds like a referral, to me.
if a referral was to 'evaluate and treat', I would NOT count it towards risk, but if it was for an expert opinion, I might.
if it was a discussion of management, see below.

here is the AMA definition of discussion (which falls under the Data column for Moderate):
"Discussion: Discussion requires an interactive exchange. The exchange must be direct and not through intermediaries (eg, clinical staff or trainees). Sending chart notes or written exchanges that are within progress notes does not qualify as an interactive exchange. The discussion does not need to be on the date of the encounter, but it is counted only once and only when it is used in the decision making of the encounter. It may be asynchronous (ie, does not need to be in person), but it must be initiated and completed within a short time period (eg, within a day or two)."
 
I found this info as I was doing further research on the topic and thought I'd share in case anyone else was had the same question as I did. This can be found in the AAPC blog at https://www.aapc.com/blog/86916-coding-ed-e-m-in-2023/. Credit to the blogger is Rae Jiminez, posted on Jan. 3, 2023.

Q: Will a consult request count as an interactive exchange, and who gets the credit? The provider who requested the consult or the other provider or both?

A: A request for a consultation is not an interactive exchange that would be considered a discussion of management or test interpretation under the data element for MDM.
 
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