Consults on Established Patients

June 1, 2008

I’m an ENT, and last week I saw a patient previously referred to me by an internist. The patient’s last visit was 13 months ago for otalgia. He is now referred to me by an ophthalmologist for an entirely unrelated medical problem (obstructed lacrimal duct). The ophthalmologist obviously wants a consult-like report. Can I bill it as a consult even though the patient is established? What if the patient was sent by the same referring doc but for an entirely different medical problem?

Question: I’m an ENT, and last week I saw a patient previously referred to me by an internist. The patient’s last visit was 13 months ago for otalgia. He is now referred to me by an ophthalmologist for an entirely unrelated medical problem (obstructed lacrimal duct).

The ophthalmologist obviously wants a consult-like report. Can I bill it as a consult even though the patient is established? What if the patient was sent by the same referring doc but for an entirely different medical problem?

Answer: Yes, you can code a consult for an established patient, regardless of the condition. For example, primary-care physicians can code for preoperative consults requested by surgeons even for patients they see all the time for related issues.

I think your bigger issue is whether this is indeed a referral or a consult. If the ophthalmologist specifically seeks your opinion, it’s a consult. If she is asking you to solve this problem for the patient to take over care - then it’s a referral and should be billed as an established visit.