Wiki Regarding consults??

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rjenn86

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I work for orthopedic surgeons. We see pt's in the office as well. If pt is referred from a doctor in our clinic (someone who doesnt specialize in the foot and ankle) and they are referred to a doctor (in same clinic) who is a foot and ankle specialist is a consult allowed?? We have been given 2 different answers and so I am wondering what the correct answer would be? Thank you in advance!
 
Consults in same practice

The answer depends on who each provider is credentialed. If a provider specializes in hand surgery and is credentialed with this specialty then yes, the "foot" surgeon can send to the "hand" surgeon in the same practice and it can be a consult (as long as the patient does not have Medicare, then it would be an established visit)

I hope this helps.

Deb Santos, CPC, CPMA
 
Their credential must be in a different specialty. We have 2 different specialties in our Ortho office and when 1 specialty refers to a different spec., they can charge for a new patient visit. Remember, if you are coding for a consult, the provider must NOT assume care for that particular issue. If they do assume care, it is a new patient visit.
 
And it helps if the referred to provider indicates "This is a 'new' patient referred by Dr. Smith for hand pain...." AND a copy of the report must go to the referring provider.
 
What if the practice specialty is Dermatology and the physician is only "general dermatology" and refers to the Mohs surgeon in the group. Would a consult be appropriate since the "general derm" does not performed Mohs surgery (even though they are same specialty?
 
I think if the documentation meets the criteria for a consult (request/report/render) and the consultant has not already agreed to assume care, then yes, you can bill as a consult within the same group and specialty.

however, be cautious of language, "referral" is not the same as "consultation".

I work in ped cardiology and we have the interventionalist and the electrophysiologist as sub-specialties within cardiology. The general cardiologist will refer to the interventionalist (same group/same specialty) for a cardiac cath. We do not bill this as consult, as it just seems like gaming the system.
 
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