Treatment doesn't bar coding anortho consult, HCFA topsider says

Why This Topic Matters

Understanding how Medicare distinguishes a consultation from a visit affects provider reporting, claim accuracy, and compliance review, especially in specialties that frequently receive referrals for evaluation and follow-up care.

Article Sections

1. Medicare consult-versus-visit policy clarification

   Introduces HCFA commentary on how consultation policy is being aligned with CPT-based concepts. Summarizes the broad Medicare policy context discussed at the conference.

2. Orthopaedic referral scenarios

   Discusses referral patterns involving orthopaedic physicians and the general distinction between initial consultation and subsequent follow-up care. Covers the types of scenarios addressed in the policy discussion.

3. Pre-operative clearance consults

   Reviews the discussion of pre-op evaluation requests and Medicare payment considerations. Addresses the broader issue of medical necessity and surgical episode payment context.

4. Policy clarification and medical necessity

   Notes the need for additional policy guidance and the role of medical necessity review in pre-operative consult questions. References ongoing work on further clarification by HCFA.