New or Established Patient Visit?

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October 31, 2013

Question:

Two of our surgeons (breast) are hospital employed and work within the Breast Center. Sometimes we see patients as direct consultations from the primary care physician and report consultations as appropriate. Our question is do we bill a consultation or a new patient visit when the patient is sent to the Breast Center after a mammogram and biopsy by the radiologist. The patient is then sent to our surgeons after the biopsy and we don’t have a specific referral from the radiologist.

Answer:

In your scenario, it does not appear there is a request for consultation from the radiologist but a transfer of care; report the new or established patient visit category as appropriate. The mammogram and biopsy have already been completed by the radiologist and is now being sent to your surgeons. The radiologist performs the testing and will not typically manage the long term care of the patient, thus any “opinion” by the surgeon will not affect any long term management by the radiologist who performed the mammogram and biopsy.

You may, on occasion have a situation where a consultation may be appropriate; but based on the information provided, the consultation requirements do not appear to be met.