Michelle Posted Tue 27th of June, 2017 18:01:14 PM
Our EHR system is set up to pull in the referring provider from the demographics, but sometimes the referring field is not updated before the office note is started. IF our provider bills a consult, and the referring physician's name is NOT referenced in that note, but documentation is in the chart (hard copy of referral, external notes requesting the consult) can we submit the consult code.
I was recently advised the provider has to append the note. Can our billing office start the append and send to the provider to sign?
SuperCoder Answered Wed 28th of June, 2017 02:56:43 AM
If the reffering provider name is not updated in the EHR but the medical documentation clearly supports 3R of consultation (Refer, Render and Report), then it is OK to bill the respective consultation code as per the documentation.
Insurance company will decide on the basis of the submitted medical records. If medical records clearly document referal note, rendered service note and report, then the provided service will be reimbursed by the insurance provider.
Please find below the SuperCoder link for more understanding on consultation: