Wiki Consult with follow up

[melaniecfuller]

I work for a Hospitalist program. We have patients that get admitted by a sergeon and after the operation will be seen by one of our Hospitalists to follow the care of the patient while they are in the hospital. Our providers are currently billing a consult code for the initial encounter then follow up codes for the entire stay. According to the CPT book a consult code should not be used when assuming the care of a pt. I have brought it to their attention but I want to be sure that I am interpreting this correctly. Any thoughts?

 

[Pam Warren]

Good question, and you're absolutely right. A consultation is an independent request for an opinion by your attending provider (in this case the surgeon) to your hospitalist. If your hospitalist is following every surgical patient as a matter of course or standing order then they can't meet the criteria for a consultation. We had this issue early on when our hosptialists were doing the exact same thing...any surgical patient who was over the age of 40, per our hosptial policy, had to be also followed by a hosptialist, who billed a consult. We had to step in and educate them about the criteria for reporting a consultation code.

Occasionally, however with a surgical patient who (because of good health and young age) does not have a standing order to be followed by the hospitalist develops a condition that requires the surgeon to ask the hospitalist to assess the patient, then as long as your documentation is appropriate (Request, Render opinion, Report) and your payer allows, you can bill a consultation or the appropriate replacement code.

 

[MikeEnos]

Pam's got it exactly right. The key here is determining the intent of the encounter. If the intent was for the provider to render an opinion or make a determination within their scope of specialty, that's a consult. If however (as appears to be the case) the intent is for the provider to assume care for the patient no matter what, then it's just an initial encounter (whether it's office outpatient or inpatient.)