Doesn't Have to Be All or Nothing I see the question of consultation coding as a particularly complicated choice for orthopedic practices, but the decision should not be made as an -all or nothing.- For patients whom orthopedists see, there are many instances when a consultation code is the correct service to bill because it is the service rendered and, hopefully, documented. You should examine several factors, including the consult request, and then decide whether a consultation is the most appropriate code to use. CPT states, -A consultation is a type of service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source.- Additionally, it states, -A physician consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit.- Ask these questions: Remembering CPT's definition, when was the last time your physician was asked for his opinion and advice on a new osteoarthritis patient? Have there been occasions when your orthopedist started a patient on a therapy, and she returned to her requesting physician for continued care? Would those instances constitute a consultation or just a new patient visit? What did the documentation show? What would an auditor think? Did you make the correct coding choice?
What You Need to Qualify If appropriately requested and documented, this visit can qualify as a consultation if your orthopedist meets the -Three R-s- of a consultation (referral from a healthcare provider, review, and report back to the referring party). Certainly, your physician would be rendering his [...]