Healthcare Consultations and Guidelines
Consulting physician should provide communication regarding their findings to the physician.
When the consultant assumes responsibility of the patient's care after the consultation, consult codes are no longer appropriate.
A consultation initiated by the patient/family is reported with the appropriate office visit code.
A consultation mandated by a third-party payer should be appended with modifier 32.
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Guidelines
- Request must come from an attending physician or other appropriate source, & the necessity for this service must be documented in the chart
- Consulting physician should provide communication regarding their findings to the requesting physician
- The consultant may initiate diagnostic and/or therapeutic services such as writing orders or prescriptions & initiating treatment plans
- The opinion rendered and services ordered or performed must be documented in the patient’s chart
- When the consultant assumes responsibility of any or all of the patient’s care subsequent to the consultation encounter, consult codes are no longer
appropriate.
- A consultation initiated by the patient or family rather than by a physician is reported with the appropriate office visit code
- Counseling and Coordination of Care
- A consultation mandated by a third-party payer should be appended with modifier 32
- Inpatient Consultations
- The consultant should only report one consultation code per admission
- Additional visits during the admission should be reported with the appropriate E&M code for subsequent hospital care
- Includes any services necessary for the consultant to complete their assessment, monitor progress, revise recommendations or examine a new
problem
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