Orthopedic Consult for Rehab

July 1, 2007

An orthopedist consults me on a postoperative patient for my recommendations for discharge planning and options for rehabilitation. I evaluate and provide appropriate feedback. If the patient qualifies for inpatient or subacute rehab, I work with social workers to arrange transfer, write orders, and do the appropriate paperwork to get the patient transferred. Is this an appropriate consult since the orthopedist is paid a “global fee” by Medicare?

Question: An orthopedist consults me on a postoperative patient for my recommendations for discharge planning and options for rehabilitation. I evaluate and provide appropriate feedback. If the patient qualifies for inpatient or subacute rehab, I work with social workers to arrange transfer, write orders, and do the appropriate paperwork to get the patient transferred. Is this an appropriate consult since the orthopedist is paid a “global fee” by Medicare?

Answer: Here is the opinion of Bill Dacey, a certified professional coder, chart auditor, and expert par excellence:

“Yes, the orthopedist is paid a global fee for his/her services related to the surgery. If he/she requests the opinion/advice of another relative to appropriate care, it’s a consult. The orthopedist didn’t give a 90-day, full-service warranty, just normal post-op evaluations. If more information or care is needed, he or she may need to enlist help. I’ve never even heard of anyone ‘capping’ the services under the ‘global’ construct. Just document the consult appropriately, and you should be fine.”