Wiki Consults in the hospital

[BonnieJ123]

I read or heard here in the last few months about consults and not billing a consult if the patient had been seen within a certain time frame by the same doctor. I am not asking about the CPT codes for hospital consults- only about a time frame if the doctor saw the same patient in an earlier hospital stay and then patient returns and doctor does a consult. Does any one know or heard about this?

 

[thomas7331]

I don't know of any coding guidelines that restrict the time frame in which a provider can perform a second consult on the same patient - assuming the definition of a consult is met for the second service, I believe it's appropriate to code it. A number of years ago, I did experience some denials from one payer in cases whenever a second consult was billed within less than 3 months, but that was just the one particular payer's guidelines and I haven't come across anything like that again since.

 

[BonnieJ123]

Thanks, this is Medicare Humana and they are saying it cannot be billed within 7 days of previous IP consult. I will call Medicare Humana and ask where they are getting this information. They stated per AAPC Manual which I could not find.

 

[BonnieJ123]

Cardiology consults

Ok I found where I read it before. Actually it is listed under AAPC 2017 Cardiology Updates Chapter 7. Here it is, "Learn the Limitations Before Reporting These Codes Because these are consult codes, you’ll recognize some familiar issues you have to watch for: transfer of care and documentation of request and report. When you see that transfer of care has occurred or that the patient has seen or will see the consulting physician, be sure to check these rules before reporting 99446-99449: Do NOT report the codes if the consultant agrees to transfer of care before the assessment.● Reporting the codes may be OK in cases where the physician couldn’t decide on transfer of care until after the● consult. The patient may be new to the consultant or may be an established patient with either a new problem or an● exacerbation.
CPT © 2016 American Medical Association. All rights reserved.

and then this is it:

If the consultant saw the patient in the last 14 days, do NOT report the codes.● If the consult leads to immediate transfer of care or another face-to-face service “within the next 14 days or next● available appointment date of the consultant,” do NOT use the codes.
This is dated Dec 15.2016. So, I wonder about billing a subday then instead of an IP initial Medicare Replacement CPT code for the consult within the 14 days.