MEDICAL BILLING NEWSLETTER .02               3/26/93
                    
                        CONSULTATION  
                        ============

A consultation is a type of evaluation & management service furnished by a
physician whose opinion or advice is requested by another physician for
further evaluation & management of a specific problem.  A consultant may
initiate diagnostic and therapeutic services.

Patient and family initiated requests for "consultations' are not reported
using the initial consultation procedure codes.
Evaluation and management services of a physician following the transfer
of the total care of the patient do not constitute a consultation.  These
services must be reported using the appropriate level of services codes.

If a consultant participated in the care of a patient in the hospital,
(concurrent care) for one or more conditions, the physician must report
the services after the completion of the consultation using the 
appropriate subsequent hospital care codes.  In the office setting, the
appropriate established patient code must be used.

Documentation Requirements:
===========================
1. In an inpatient setting, the request may be documented as part of a 
plan written in the requesting physician's progress note, an order in a
hospital record, or a specific written request for the consultation.

2.  In an office setting, the requirement may be met by a specific written
request for the consultation from the  requesting physician or if the
consultant's records should show a specific reference to the request.

PRE-OP CLEARANCE   (diagnosis 799.9)
Physician billing for a preoperative medical evaluation (clearance for
surgery) by a physician other than the operation surgeon:

1. A request from a surgeon to a patient's primary care physician for
the purposes of "clearing" the patient for surgery or completing a history
and physical for inclusion in the patient's medical records is considered
a referral. It does not constitute a request for a consultation because the 
primary care physician is responsible for the overall management of the
patient, which makes the use of the consultation codes inappropriate.

2. If the request is to a physician who has not provided services to
the patient within the past three years, then that physician may
use the appropriate consultation codes.

UPDATE Nov-Dec page 34 supersedes information of UPDATE  December 1991 page 54.

INITIAL OBSERVATION CODES (99221-99220)
Medicare has advised this code may be used for the day that the
patient is in the "observation" status, watch for a change from HCFA.
The intent of the AMA in definition was to be similar to that of the  initial
Hospital Care. (Until changed, code as per Medicare Update Jan/Feb pg 31).