Chart Records Review

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My physician referred a patient out to see a NeuroPsych. We received back
a 14 page consult report.



My physician now wants to bill the patient a "records review/99358" for the
time he spent in reviewing the received consultation report.



I don't believe we can bill for him to review a report for a referral that
we made?



Cheryl Sarnowski, Administrator

2137 West State Road 434

Longwood, FL 32779-4983

Email: Cheryl@headache-institute.com





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My =
 physician referred a patient out to see a NeuroPsych.  We =
received back a 14 page consult report.

 

My physician =
now wants to bill the patient a “records review/99358” for =
the time he spent in reviewing the received consultation =
report.

 

I don’t believe we can bill for him to review a =
report for a referral that we made?

 

Cheryl Sarnowski, =
Administrator

2137 West State =
Road 434

Longwood, FL =
32779-4983

Email: =
Cheryl@headache-institute.com

 

 

This =
electronic mail/email message and any attachments may contain =
confidential and/or private information intended solely for a specific =
individual and purpose and is protected by law.  If you are not the =
intended recipient of this email, you are hereby notified that any =
disclosure, copying, or distribution of this email and any attachments, =
or the taking of any action based thereon, is strictly prohibited.  =
If you have received this email in error, please notify the sender by =
reply email or call 407-644-3737 x 114.  Thank =
you.

 

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Comments

  • edited May 2017
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    Cheryl:



    You will get a lot of answers for this, including 'Medicare doesn't cover' -
    so it just requires putting it in perspective.



    There are several thoughts/questions:



    -Will your physician use the report to treat the patient, or is the report
    outlining the treatment the consultant will provide to the patient, (if the
    patient chooses to continue care with the consultant)?



    -Part of an E/M service scoring can be attributed to records review. Is
    your physician contacting the patient to come in and discuss the
    consultant's report? If so, this could meet documentation requirements to
    recover some compensation for the records review.



    Billing a patient for a service has multiple parameters, including: Is it
    covered by the patient's health plan? Can you bill outside of the plan per
    your contract? Was the patient informed that there may be a non-covered
    charge they can be obligated to?







    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



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    See below



    Cheryl Sarnowski, Administrator

    c/o Marc Irwin Sharfman, MD PA

    2137 West State Road 434

    Longwood, FL 32779-4983

    Phone: 407-644-3737 x 114

    FAX: 407-644-3009

    Email: Cheryl@headache-institute.com





  • edited May 2017
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    If that's the case, he would have the patient come back for another visit to
    discuss a treatment plan and the records review is part of the E/M scoring
    process (as long as it is documented).



    If the patient is self-pay, then you have no restrictions on what you charge
    the patient, but would still need to meet the state's guidelines for the
    practice of medicine's documentation requirements. Therefore, you should be
    able to charge for records review, however it is good business to inform
    patients in advance of possible additional charges.



    Keep in mind that some self-pay patients are applying for state Medicaid,
    and if you are participating - and the coverage is retroactive, this could
    all become moot (charging for records review).



    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



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    Thanks Karen . Couldn't agree with you more.



    I am comfortable billing records review when it's warranted and perhaps
    outside of the E/M (and within guidelines) .. I was just concerned about
    billing for him to review a consult report from a doctor that we asked to
    provide the consult on and then bill patient for my physician to review. In
    this particular case I just felt it should be part of the next E/M etc.



    Cheryl Sarnowski, Administrator

    c/o Marc Irwin Sharfman, MD PA

    2137 West State Road 434

    Longwood, FL 32779-4983

    Phone: 407-644-3737 x 114

    FAX: 407-644-3009

    Email: Cheryl@headache-institute.com




  • edited May 2017
    Generally this code has to be billed "in addition to" other services. I
    wouldn't think this is any different from receiving any other consult he
    received that was 3 or 4 pages. This code is used most often when a new
    physician comes on board with a complicated hospital case or the patient is
    extremely complex. I would prefer to be conservative rather than try to
    prove my point should the case be reviewed.

    "Prlonged evaluation and Management service *before and/or after direct
    (face-to-face)* patient care ." That says it all in my opinion.

  • He could include it in his encounter's work for the patients next visit.

    Donna Fickes
    Patient Account Manager
    Center for Arthritis & Rheumatic Diseases PC
    757 461 6997 ext 2
    djfickes@centerforarthritis.com

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