Is this a consultation??

REQUESTING PHYSICIAN: MD is documented
REASON FOR REQUEST: Postop management of atrial fibrillation.

PRESENTING HISTORY: This is a 79-year-old female who is status post right
total knee replacement today. She currently feels well. Denies chest
pain, nausea or shortness of breath.

ALLERGIES:
1. AMITRIPTYLINE.

HOME MEDICATIONS:
1. BuSpar 5 mg b.i.d.
2. Rocaltrol 0.25 mcg b.i.d.
3. Calcium 400 mg t.i.d.
4. Caltrate 600 mg at bedtime.
5. Citrucel at bedtime.
6. Premarin vaginal cream 0.5 g at bedtime twice weekly.
7. Coumadin 5 mg daily five days a week and 2.5 mg on Sundays and
Wednesdays.
8. Crestor 10 mg q.p.m.
9. Pepcid AC 20 mg p.r.n.
10. Synthroid 100 mcg daily except for 50 mcg on Sundays.
11. Tylenol p.r.n.
12. Vitamin C 250 mg daily.

PAST MEDICAL HISTORY: Atrial fibrillation, hypothyroidism,
hypoparathyroidism, mycosis fungoides - currently in remission,
hyperlipidemia, anxiety, GERD and atrophic vaginitis.

SOCIAL HISTORY: She lives with her husband. She has four children, one
daughter who lives nearby. She does not smoke or drink alcohol.

FAMILY HISTORY: Mother died at 48 with renal failure. Father died at 66
with CHF. There is no diabetes.

REVIEW OF SYSTEMS: All systems reviewed and found to be negative except as
noted in the HPI.

PHYSICAL EXAMINATION:
GENERAL: Pleasant elderly female in no acute distress.
BLOOD PRESSURE: 131/69, but it has been as high as 184/85 postop.
PULSE: 91.
TEMPERATURE: Afebrile.
HEENT: PERL, EOMI, conjunctivae clear. Pharynx, mucous membranes moist.
NECK: Supple, no nodes, no bruits, no JVD.
LUNGS: Clear.
CARDIAC: Regular rate and rhythm. No murmurs or gallops.
ABDOMEN: Soft and nontender. Normoactive bowel sounds.
EXTREMITIES: No edema, pulses 2+ and equal. She has bulky dressing on the
right knee.
NEUROLOGIC: Nonfocal.
PSYCH: Alert and oriented x3, normal affect.

LABORATORY DATA: INR today is 1.1, potassium 3.9, hemoglobin from a preop
evaluation on June 8, 2009 is 13.3 with a white count 9.86 and creatinine
is 0.67.

ASSESSMENT AND PLAN: A 79-year-old female with hyperlipidemia,
hypothyroidism, hypoparathyroidism and atrial fibrillation who is now
status post right total knee replacement. Postop, she is doing well,
although her blood pressure is a little elevated. I will start Vasotec
1.25 mg q.6h. p.r.n. hypertension. Her atrial fibrillation is controlled
at this time and anticoagulation will be managed by orthopedic physician.
Thank you for allowing me to participate in the care of this very pleasant
patient. I will follow her with you.

Thanks for any help- Medcoder

management

Postop management of atrial fibrillation
Management is not a consultation.

Yes and no

Yes, every doctor in America would bill a consultation for A fib, and No, Medicare would say that your doc is taking over the care of that issue from the surgeon who never treats A fib so it is not a consultation.

Post op care and consults

Look at this article:

http://www.codapedia.com/~article_154_.cfm

You'll have to paste it into your browse, or search on the title. It's called Post op care and hospitalists and it quotes the Medicare manual on the topic.

Consultation

This goes back to a question I asked a long time ago....I've come to the realization that by pure definition this is not a consultation because the requesting physician is not really asking for your opinion because he can't figure out what's going on...he knows what the problem is (Afib) and he wants you to take care of it and deal with it so that he (an orthopedist) doesn't have to. Having said that...every doctor I know would call this a consult. This is the problem I have with the coding system and Medicare in general. They don't pay attention to how doctors think. Instead they have rules that are difficult to figure out in real life. If that weren't the case, we wouldn't need Codapedia. Everything would be easy and straightforward...

Rumor has it that CMS is going to do away with the consultation codes for 2010 (making this discussion meaningless for next year). Does anyone have any info on this?

Consultation

Rumor is correct. CMS has proposed eliminating paying for consults in their Proposed Physician Fee Schedule. Comments are being accepted until Aug 31, and the final rule will be issued no later than Nov 1.

There is an article that summaries it. Search, "no more consults" or paste this link into your browser:

http://www.codapedia.com/~article_405_.cfm

When you read the section in the rule, they are critical of the AMA for not helping them define a transfer of care.

Is this a consultation??

Exactly as I thought. Thank you to all.

Medcoder