Re: Can we bill consult code for a nursing home visit????

[Steve Verno]

Sahi

Conults are for an opinion, NOT to meet with the patient to discuss treatment. so NO you cannot bill for a consult if it doesnt meet the definition of a consultation. It doesnt matter where services are rendered. 

I have 2 doctors doing this to me. Both are under investigation for fraud charges. 

It doesnt matter if the doctor checked consult.  IT STILL MUST MEET THE CPT DEFINITION  (Caps for emphasis not yelling).

Some simple advice. The NH patient may be the parent of a govt investigator.  He charges a consult when it is NOT a onsult.  The NH child sees this and now the doctor is under investigation.  So will you be for allowing this to be billed.

[Steve Verno]

Thanks michelle.  When I see NH, i think of new hampshire.  comes from living in Massachusetts for 8 years and traveling to new hampshire alot. 

The problem still remains which is what do they mean by a consult as it pertains to the first check up. 

Simply put a consultation must meet the CPT requirements.  Too many people think that speaking or meeting with the patient to discuss the health care about to be provided qualifies for a consult. Wht has been driving this thread is what was posted:  first check up.  To me this means performing treatment or the discussion of treatment.  But without more info, we cant proceed further.  Also, this could be a test question:  Can consutations be performed in a nursing home?  Which may be why we arent getting a clear response.

One provider who did this with me still insists that my insurance and I pay for a consultation. This is after sending him a 20 page response that he is wrong.  Im now getting calls from a collection agency demanding I pay this.  I continue to refuse and have now turned the doctor over to the Department of health due to a violation of Florida law and Ive filed a qui tam complaint wih the OIG and CMS. 

[Steve Verno]

Again, you havent answered my question.

Sadly, your question cant be answered without providing us with answers.

Now, for another question, why cant a consultation code be billed in new Hampshire?  Do you know of a NH state law proibiting certain CPT Codes.

One more question.  You want to bill a consultation for a check up? is that what you're asking??

[Steve Verno]

I was in first year Algebra for four years.  The algebra book had all the answers in the back.  My teacher didnt care if we had the right answer.  She wanted to know how we came up with our answer.

X+Y = 10
x=7

She wanted to see:  if x+y=10 and X = 7, then 10-X = Y so
10-7 = 3

Some people think a meeting with a patient to discuss treatment is a consult hence they are able to bill the consult codes. 

In 2010 CMS no longer pays for consults.  Florida Medicare has published the 2010 fee schedule and lo and behold, the consult codes are NOT listed and NO fees.  The 2010 CPT coding changes are out.  The consult codes are still there.  Many providers have contracts where the reimbursement is tied to the Medicare allowable.  It doesnt matter if the consult codes are still present.  If the providers reimbursement is tied to the Medicare allowable, the provider gets bupkiss for payment. 

I had a thought.  It could be possible that this is a test question, hence the inability to provide the info requested.    I could be wrong, as usual.

[Steve Verno]

Sahi, its simple.

Your question is can we bill consult code on first check up

My question is, how do you define a consult?

Its a simple question

Without an answer, we cant help you.  We need to know what you mean by consult, and we dont need to know the codes or the code definition.

so, please stop being evasive.  Just answer my question.

To add. The patient is in the nursing home.  Your provider goes in, meets with the patient in the nursing home and discusses the plan of care with the patient on this first visit.  Is this what is happening???

[Steve Verno]

I know the definitions of the codes. 

My question is still the same,

How do you define a consult

YOU're also asking if you can use the consultation codes in New Hampshire?

Im now more confused.  Why cant you use consultation codes in New Hampshire?  But, to understand your first post, what do you mean by consultation and I dont mean the codes and their descriptors.  What do you mean by a consultation.  How do YOU define it?

Being evasive doesnt win friends and influence people.

[Steve Verno]

Thats true!

[Adam Mlynarcik]

You won't be billing consult codes anyway in about a month and a half.  At least not to Mcare or Mcaid. 

[Steve Verno]

Thanks.  I meant what do you define as a consult?

Meeting with the patient to discuss treatment?

[Steve Verno]

What do you mean by consult???