decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 4 (April)
Remember the rules governing consultations
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Article Overview
This article reviews the general requirements for reporting consultation services in the outpatient setting, with emphasis on Medicare documentation expectations and compliance basics. It is aimed at coding and billing professionals, especially those working with gastroenterology and other specialties that receive requested opinions on patient evaluation and management. The discussion focuses on how consultation services differ from routine visits, what documentation elements should be present, and the administrative steps that support proper reporting.
Why This Topic Matters
Consultation services are subject to specific documentation and reporting requirements, and misunderstanding those requirements can affect claim accuracy and compliance. This article helps readers recognize the major considerations that distinguish consults from other evaluation and management visits.
What You Will Learn
- The general requirements for reporting consultation services
- How consultation documentation is expected to support the request and the response
- What distinguishes consultation services from routine office or outpatient visits
- How counseling or time-based billing may relate to consultation encounters
- The general role of Medicare guidance in consultation compliance
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Compliance professionals
- Gastroenterology practices
- Physician office staff
Codes Discussed
Code Ranges Discussed
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