OIG Adds Consults to Injury

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article discusses increased federal attention on physician consultation billing and the documentation issues that can make a service look like a consultation versus another type of evaluation and management encounter. It is aimed at physicians, office staff, coders, and compliance professionals who need to understand the general documentation themes and audit risk surrounding consult claims. The article focuses on broad guidance about documentation, communication between physicians, and why consult billing attracted scrutiny from OIG and CMS.

Why This Topic Matters

Consult billing was a common audit focus, and inadequate documentation could affect reimbursement and compliance risk. Understanding the distinction discussed in the article helps practices reduce denials, audits, and billing disputes.

What You Will Learn

  • Why consult billing drew heightened audit attention
  • The documentation themes that matter when a patient is sent from one physician to another
  • How communication between referring and receiving physicians affects billing risk
  • Why confirmatory documentation can be relevant to consult claims

Who Should Read This

  • Physicians
  • Medical coders
  • Billing staff
  • Compliance professionals
  • HIM professionals
  • Practice administrators

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