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Billing for a Specialist Regular or Consult E/Ms

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dmaney:
My doctor recently saw an HMO patient that was referred by her PCP.  Do I bill the E/M as a consult or normal new patient E/M?   (my doctor communicated the results to the PCP and has taken over care of the patient).  I'm thinking a consult.  Is that right?

When my doctor sees this patient again, it's a regular established patient E/M?


In the case where a patient has not been referred, then it is a regular E/m.  Right?

Don't want to make mistakes.  Many thanks. 

Michele:
Are you a coder or the biller?  This is something that can't be answered based only on the info provided.  Really the dr who was in the room , or a coder with access to the patient's medical record would have to decide if the specifications for a consultation or an E&M code. 

Also, Medicare and many other insurances do not allow for consultation codes.  Medicare advises providers to use E&M codes.  Here is a link with more information on the consultation codes:

http://ep.yimg.com/ty/cdn/pmiconline/CONSULT-CODES.PDF 

dmaney:
Thank you! 

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