Consultation 5 R’s
Posted on 24. Mar, 2009 by Editor in Toolkit
Miss 1 element, and invite auditors to check out your 99241-99255 claims to Medicare.
Without a documented reason or a written report for the requesting physician, your physician won’t see Medicare payment for consultations. Keep the five R’s of a consultation handy with this checklist.
1. Reason: Both the requesting and consulting physicians must document a medically necessary reason for a consultation. Therefore, the reason for the consultation must satisfy medical necessity, and both physicians need to clearly state that reason in the records.
2. Request: The request must come from another physician or qualified nonphysician practitioner (NPP). CPT also allows requests from other appropriate sources, so check with your payers to determine what they consider valid consult request sources. For compliance, the consultant should verify the request from a requesting source in his medical records.
3. Render: The consultant must render services during which he may initiate diagnostic and/or therapeutic services.
4. Report: The consultant must issue a written report of his findings, advice and opinions to the requesting source.
5. Return (recommended by consultants): To show that a transfer of care didn’t occur, the consultant should eventually send the patient back to the referring physician.
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