Wiki E/M Help!!!!!!

[HAPPYCODER]

I work for an Orthopaedic group and there has been a lot of debate lately about New Patient vs Consultations.

Say John Doe is referred by PCP for fx wrist. The ortho doc sees and treats the patient. Is this a consult or a new patient?

Say Jane Doe is referred by PCP for torn ACL. The Ortho doc sees the patient and plans surgery. Consult or New Patient?

The physician feels that if Dr. Smith send or calls him to see/treat a pt for fx or scoliosis.....it's a consult.

 

[camcpc@yahoo.com]

Is Dr. Smith apart of the orthopedic group? If he is, has the PT been seen within the last 3 yrs? Check the E/M guidelines, then PT is not new. camcpc@yahoo.com

 

[HAPPYCODER]

No....Dr. Smith is a pcp

 

[mitchellde]

It is not a consult if the referring provider already knows what the problem is and realizes they are not the appropriate provider to address the issue. The referring provider must be asking a question from the physician for it to be a consult, in the 2 cases you have related there is no question to address rather known problems the PCP does not have the necessary expertise to fix.

 

[HAPPYCODER]

Thanks! I am having a hard time getting the doctor to understand this!

 

[LisaG81]

This is always tricky for me too - because too often the PCP sends the patient to our Ortho practice with a completely incorrect diagnosis. For example, they'll say the patient has a fracture but they really don't.

I think this will eventually become irrelevant anyway because we're seeing more and more payers not covering consult codes anymore. It's not just Medicare. So we generally code new patient unless it's very clearly a consult.