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Re: [MedicalBillers] Entering Referring Physician Info

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  • B Burgess
    In that case, it is NOT a consult, and not a 99243.  If the patient was not sent by a medical provider who was requesting an opinion or advice regarding the
    Message 1 of 5 , Jul 2, 2008
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      In that case, it is NOT a consult, and not a 99243.  If the patient was not sent by a medical provider who was requesting an opinion or advice regarding the patient AND no communication was sent back to the provider who requested the "consult" giving the consultant's opinion and/or advice, then your patient is merely a New Patient and the service should be billed from the 99201-99205 series of codes.
       
      Barbara Burgess, RN, CPC, ACS-EM, PCS
      University of South Alabama
      Coding & Compliance Nurse Specialist

      --- On Wed, 7/2/08, nicole mezni <nmezni@...> wrote:

      From: nicole mezni <nmezni@...>
      Subject: [MedicalBillers] Entering Referring Physician Info
      To: MedicalBillers@yahoogroups.com
      Date: Wednesday, July 2, 2008, 8:59 PM






      Hello everyone,

      I have a new pt consult to bill (99243), and the person who referred the pt was someone from his place of worship.

      How do I document that on the claim, if a physician did not refer them? I obviously don't have an NPI to enter or anything?

      Thanks!!!

      Nicole Mezni

      [Non-text portions of this message have been removed]


















      [Non-text portions of this message have been removed]
    • nicole mezni
      Thank you so much, Barbara!!!!!!! Nicole Mezni ... From: B Burgess To: MedicalBillers@yahoogroups.com Sent: Wednesday, July 02, 2008 11:07 PM Subject: Re:
      Message 2 of 5 , Jul 2, 2008
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        Thank you so much, Barbara!!!!!!!

        Nicole Mezni

        ----- Original Message -----
        From: B Burgess
        To: MedicalBillers@yahoogroups.com
        Sent: Wednesday, July 02, 2008 11:07 PM
        Subject: Re: [MedicalBillers] Entering Referring Physician Info


        In that case, it is NOT a consult, and not a 99243. If the patient was not sent by a medical provider who was requesting an opinion or advice regarding the patient AND no communication was sent back to the provider who requested the "consult" giving the consultant's opinion and/or advice, then your patient is merely a New Patient and the service should be billed from the 99201-99205 series of codes.

        Barbara Burgess, RN, CPC, ACS-EM, PCS
        University of South Alabama
        Coding & Compliance Nurse Specialist

        --- On Wed, 7/2/08, nicole mezni <nmezni@...> wrote:

        From: nicole mezni <nmezni@...>
        Subject: [MedicalBillers] Entering Referring Physician Info
        To: MedicalBillers@yahoogroups.com
        Date: Wednesday, July 2, 2008, 8:59 PM

        Hello everyone,

        I have a new pt consult to bill (99243), and the person who referred the pt was someone from his place of worship.

        How do I document that on the claim, if a physician did not refer them? I obviously don't have an NPI to enter or anything?

        Thanks!!!

        Nicole Mezni

        [Non-text portions of this message have been removed]

        [Non-text portions of this message have been removed]





        [Non-text portions of this message have been removed]
      • B Burgess
        Anytime !!  We go round and round with our docs all the time (especially the specialists who think they are, well, SPECIAL !) about the difference between a
        Message 3 of 5 , Jul 2, 2008
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          Anytime !!  We go round and round with our docs all the time (especially the specialists who think they are, well, SPECIAL !) about the difference between a consult and a referral, and that even if it IS intended to be a consult that if there is no communication back to the requesting provider that the consult criteria has not been met and it is not billable as a consult.  And, just because there is a "referring" physician, that still doesn't automatically make it a consult !
           
          My husband recently saw a GI doc only because I have bugged him for 3 years about getting a screening colonoscopy based only on the fact that he is over 50.  He picked one out of the phone book and made an appt.  I got the insurance EOB and had a fit............ the visit was billed as a 99245 - a HIGH level consult.  NO chief compliant, no problems, no nothing. Very little in the way of exam, no labs, xrays, prescriptions, etc.  Just scheduled him for the procedure.  And, to make matters worse, he saw that nurse practitioner, but the service was billed in the docs name (we have BCBS).   It was enough to make me call and request that they refund the $$ to my insurance company for the services that were billed AND NOT PROVIDED.  I was nice about it, but insistant. The office manager's explanation was that my husband's primary care doc was noted on the chart.  His primary care didn't even have a clue that he was going to a GI doc !!  They just
          happened to ask him who his regular doctor was, so he answered their question !   I was told that they would refund and rebill; We'll see what happens...................
           
          Barbara

          --- On Wed, 7/2/08, nicole mezni <nmezni@...> wrote:

          From: nicole mezni <nmezni@...>
          Subject: Re: [MedicalBillers] Entering Referring Physician Info
          To: MedicalBillers@yahoogroups.com
          Date: Wednesday, July 2, 2008, 10:14 PM






          Thank you so much, Barbara!!!!! !!

          Nicole Mezni

          ----- Original Message -----
          From: B Burgess
          To: MedicalBillers@ yahoogroups. com
          Sent: Wednesday, July 02, 2008 11:07 PM
          Subject: Re: [MedicalBillers] Entering Referring Physician Info

          In that case, it is NOT a consult, and not a 99243. If the patient was not sent by a medical provider who was requesting an opinion or advice regarding the patient AND no communication was sent back to the provider who requested the "consult" giving the consultant's opinion and/or advice, then your patient is merely a New Patient and the service should be billed from the 99201-99205 series of codes.

          Barbara Burgess, RN, CPC, ACS-EM, PCS
          University of South Alabama
          Coding & Compliance Nurse Specialist

          --- On Wed, 7/2/08, nicole mezni <nmezni@.... com> wrote:

          From: nicole mezni <nmezni@.... com>
          Subject: [MedicalBillers] Entering Referring Physician Info
          To: MedicalBillers@ yahoogroups. com
          Date: Wednesday, July 2, 2008, 8:59 PM

          Hello everyone,

          I have a new pt consult to bill (99243), and the person who referred the pt was someone from his place of worship.

          How do I document that on the claim, if a physician did not refer them? I obviously don't have an NPI to enter or anything?

          Thanks!!!

          Nicole Mezni

          [Non-text portions of this message have been removed]

          [Non-text portions of this message have been removed]

          [Non-text portions of this message have been removed]


















          [Non-text portions of this message have been removed]
        • Weis, LuAnn
          Barbara, That happened to me also. Meanwhile, the GI doc knew that I work for the compliance dept. @ the hospital where he was performing my colonoscopy. I
          Message 4 of 5 , Jul 3, 2008
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            Barbara,

            That happened to me also. Meanwhile, the GI doc knew that I work for the
            compliance dept. @ the hospital where he was performing my colonoscopy.
            I educated him just as I would if he was on our faculty practice staff!!
            The money went right back to the hospital's self-insured manage care
            company!



            LuAnn Weis, MPA
            Compliance Specialist


            -----Original Message-----
            From: MedicalBillers@yahoogroups.com
            [mailto:MedicalBillers@yahoogroups.com] On Behalf Of B Burgess
            Sent: Wednesday, July 02, 2008 11:35 PM
            To: MedicalBillers@yahoogroups.com
            Subject: Re: [MedicalBillers] Entering Referring Physician Info



            Anytime !! We go round and round with our docs all the time (especially
            the specialists who think they are, well, SPECIAL !) about the
            difference between a consult and a referral, and that even if it IS
            intended to be a consult that if there is no communication back to the
            requesting provider that the consult criteria has not been met and it is
            not billable as a consult. And, just because there is a "referring"
            physician, that still doesn't automatically make it a consult !

            My husband recently saw a GI doc only because I have bugged him for 3
            years about getting a screening colonoscopy based only on the fact that
            he is over 50. He picked one out of the phone book and made an appt. I
            got the insurance EOB and had a fit............ the visit was billed as
            a 99245 - a HIGH level consult. NO chief compliant, no problems, no
            nothing. Very little in the way of exam, no labs, xrays, prescriptions,
            etc. Just scheduled him for the procedure. And, to make matters worse,
            he saw that nurse practitioner, but the service was billed in the docs
            name (we have BCBS). It was enough to make me call and request that
            they refund the $$ to my insurance company for the services that were
            billed AND NOT PROVIDED. I was nice about it, but insistant. The office
            manager's explanation was that my husband's primary care doc was noted
            on the chart. His primary care didn't even have a clue that he was
            going to a GI doc !! They just
            happened to ask him who his regular doctor was, so he answered their
            question ! I was told that they would refund and rebill; We'll see
            what happens...................

            Barbara

            --- On Wed, 7/2/08, nicole mezni <nmezni@...
            <mailto:nmezni%40cfl.rr.com> > wrote:

            From: nicole mezni <nmezni@... <mailto:nmezni%40cfl.rr.com> >
            Subject: Re: [MedicalBillers] Entering Referring Physician Info
            To: MedicalBillers@yahoogroups.com
            <mailto:MedicalBillers%40yahoogroups.com>
            Date: Wednesday, July 2, 2008, 10:14 PM

            Thank you so much, Barbara!!!!! !!

            Nicole Mezni

            ----- Original Message -----
            From: B Burgess
            To: MedicalBillers@ yahoogroups. com
            Sent: Wednesday, July 02, 2008 11:07 PM
            Subject: Re: [MedicalBillers] Entering Referring Physician Info

            In that case, it is NOT a consult, and not a 99243. If the patient was
            not sent by a medical provider who was requesting an opinion or advice
            regarding the patient AND no communication was sent back to the provider
            who requested the "consult" giving the consultant's opinion and/or
            advice, then your patient is merely a New Patient and the service should
            be billed from the 99201-99205 series of codes.

            Barbara Burgess, RN, CPC, ACS-EM, PCS
            University of South Alabama
            Coding & Compliance Nurse Specialist

            --- On Wed, 7/2/08, nicole mezni <nmezni@... <mailto:nmezni%40cfl.rr>
            . com> wrote:

            From: nicole mezni <nmezni@... <mailto:nmezni%40cfl.rr> . com>
            Subject: [MedicalBillers] Entering Referring Physician Info
            To: MedicalBillers@ yahoogroups. com
            Date: Wednesday, July 2, 2008, 8:59 PM

            Hello everyone,

            I have a new pt consult to bill (99243), and the person who referred the
            pt was someone from his place of worship.

            How do I document that on the claim, if a physician did not refer them?
            I obviously don't have an NPI to enter or anything?

            Thanks!!!

            Nicole Mezni

            [Non-text portions of this message have been removed]

            [Non-text portions of this message have been removed]

            [Non-text portions of this message have been removed]

            [Non-text portions of this message have been removed]




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