2010 Consults - NON Medicare

Please bare with me....
In the 2010 CPT book it state "A consultation is a type of evaluation and management service provided by a physician at the request of another physician or appropriate source to either recommend care for a specific condition or problem or to determine whether to accept responsibility for ongoing management of the patient's entire care or for the care of a specific condition or problem"

So, my question is...as a speciality, really, most of our "consults" really are consults?? - I really am not liking consults!! -
Does this statement hold true?

It is a consult the first time the patient is seen. If treatment is started and is managed by your doc, all visits by your doc for that specific treatment are follow up E/m's. If you doc is asked for opinion regarding a different dx during that time of tx or after, he can bill the consult again.

Thank you!!
Tam

You had me at "bare"

Your posting is exactly why CMS is eliminating Consultation codes- no one really understands when a consultation is a consultation and not a referral to assume care. The commercial insurers will follow soon so don't kill yourself trying to figure it out.

But if you must, type Consultation into the Look It Up! box and browse the articles.

Consults

Non-Medicare
You do not code consults because you are a "specialty". You code consults (non-Medicare) when the criteria is met:
Note the Request for opinion from PCP (Name);
Note the reason you are being asked to evaluate;
Note your findings (H&P and MDM, plan and recommendation);
Send report back to requesting physician (outpatient).

Non Medicare consults

I think the AMA muddied the waters. They took the transfer of care concept, which CMS says the physician community never understood anyway, and moved it from Medicare patients to commercial patients. I wrote an article about it on Codapedia called, "CPT Consult Rule Changes for 2010"