Wiki Need some consult vs E/M pt advice

[Jess1980]

I have a GI practice that sees patients from another GI. The other GI in town left. The dr that left was in a separate practice. We are seeing lots of their patients for the first time but not as a second opinion or a transfer from their care. We are seeing them with a referral request from their PMD. However, they have seen doc in our specialty in the last year in most cases.

For these new patients, the other GI doc left town and did not transfer the patients. After he left, they had no GI doc and the pediatricians sent new referral requests to evaluate and manage their chronic GI complaints. No second opinion was requested and in almost all cases no continuation of care was requested. For many of them, we didn't know they saw the previous GI doc from the paperwork until we interviewed the patients during the visit. We always send letters back to the referring doc with the items you listed included.

Would you code these as a new pt or consult? I am leaning towards new pt.

 

[mhstrauss]

I have a GI practice that sees patients from another GI. The other GI in town left. The dr that left was in a separate practice. We are seeing lots of their patients for the first time but not as a second opinion or a transfer from their care. We are seeing them with a referral request from their PMD. However, they have seen doc in our specialty in the last year in most cases.

For these new patients, the other GI doc left town and did not transfer the patients. After he left, they had no GI doc and the pediatricians sent new referral requests to evaluate and manage their chronic GI complaints. No second opinion was requested and in almost all cases no continuation of care was requested. For many of them, we didn't know they saw the previous GI doc from the paperwork until we interviewed the patients during the visit. We always send letters back to the referring doc with the items you listed included.

Would you code these as a new pt or consult? I am leaning towards new pt.

Based on the info you gave here, I'm also leaning towards new patient. The key point to qualifying for a consult, is that the referring MD must REQUEST a Consult. If that isn't documented by either the referring or rendering provider, then the service doesn't qualify for a consult. To me, this sounds more like a transfer of care...getting established with a new GI since the patient's previous GI is no longer practicing in the area.

Here's a link I came across awhile back and saved; very clearly explains the difference, so that even doctors can understand!

https://www.bcbsal.org/providers/manuals/providerManual/consultationsVsReferrals.cfm

Hope that helps!

 

[Jess1980]

THANK YOU THANK YOU THANK YOU!! I was also leaning towards a new patient but wanted to check with the other coders to see if I was missing something. A few physicians were adamant that they were consults.