Wiki Office Visit vs Consult

[Butterfly1972]

Hi Group,

If we have a request from another physician for a Pre-Op evaluation on a patient. Would this be considered a form of a Consultation?

Example: Established patient with our group, we may see this patient a couple times a year, but their GI doc or Ortho doc send over a request for a Pre-op. Since the patient is already established under our group. Would this be a regular Office Visit or can we bill as and "Consultation" since we have a direct request and have to send a response?

Thanks for your feedback.

 

[MnTwins29]

Hi Group,

If we have a request from another physician for a Pre-Op evaluation on a patient. Would this be considered a form of a Consultation?

Example: Established patient with our group, we may see this patient a couple times a year, but their GI doc or Ortho doc send over a request for a Pre-op. Since the patient is already established under our group. Would this be a regular Office Visit or can we bill as and "Consultation" since we have a direct request and have to send a response?

Thanks for your feedback.

From the CPT Assistant, September 1996: "After the consulting physician completes the initial consultation, if that physician assumes responsibility for managing ALL OR A PORTION OF THE PATIENT'S CONDITIONS (caps mine), then he or she should not report the consultation code."

If your doctor is already managing conditions that are documented in this visit, such as hypertension and that is why the surgeon is requesting a pre-op from your physician, then no, you cannot report this as a consultation.

 

[Butterfly1972]

Thanks for the response. However, if the patient falls under the NEW Patient then this will be fine to bill as a Consult. Even if we have seen the pt for the conditions before....

 

[MnTwins29]

Thanks for the response. However, if the patient falls under the NEW Patient then this will be fine to bill as a Consult. Even if we have seen the pt for the conditions before....

If your doc has seen the patient before, and this qualifies as a new patient, that would mean your doc hasn't treated that patient in three years. Also, note that the CPT assistant guidance refers to whether the consulting physician assumes care for any of the conditions treated. Using my hypertension example, if the patient is coming in for pre-op before an orthopedic procedure and the ortho surgeon does that, but your doc follows up treatment on the HTN, then no, you can't bill as a consult because your doc is taking over that part of the patient's treatment. He or she can only refer all treatment back to the requesting physician. Doesn't matter whether your doc has seen the patient for these conditions before or not.