Medicare Compliance & Reimbursement - 2021 Issue 1
Reader Questions: Consult Guidelines Before Billing These Codes
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Article Overview
This reader Q&A covers how outpatient consultation services are generally discussed in medical coding practice, with emphasis on documentation elements, the relationship between the consulting and referring physicians, and the need to check payer rules. It is aimed at coders, billing staff, and physicians who handle evaluation and management reporting and want to understand when consultation reporting may be affected by payer policy.
Why This Topic Matters
Consultation reporting can depend on documentation, physician relationships, and payer recognition of the service type. Understanding the article helps readers recognize the general compliance and workflow issues involved in reporting these visits.
Article Sections
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Question
A reader asks about billing a physician consultation when the patient is already under care of another physician and whether assuming ongoing care affects reporting.
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Answer
The response discusses general consultation reporting concepts, required documentation elements, communication back to the requesting physician, and the effect of payer policy on how the visit may be reported.
What You Will Learn
- How outpatient consultation services are discussed in coding guidance
- What general documentation elements are associated with consultation reporting
- How payer policy can affect reporting choices for these visits
- How patient status and physician relationships can influence evaluation and management reporting
Who Should Read This
- Medical coders
- Billing staff
- Physicians
- Practice managers
- Compliance staff
Codes Discussed
Code Ranges Discussed
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