What is the RRR Rule in Coding Consultations

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RRR Rule In Coding Consultations
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• Evaluation and management (E/M) codes are among
  the major categories of codes that are frequently
  examined by third-party insurance auditors.
  Medicare auditors recently have seen many cases
  in which documentation guidelines are not
  followed adequately to support a consultation
  code.
• The key reason the documentation is scrutinized
  is that the reimbursements for consultations are
  higher than the reimbursement levels for office
  visits of similar documentation levels. In most
  instances, if the guidelines were not accurately
  followed, the consultation was either down coded
  or denied. In either case, money is taken back
  from the practice or the physician. Medical
  Coding Jobs for Pharmacy Freshers

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• The office/outpatient consultation codes,
  99241-99245, and the inpatient consultation
  codes, 99251-99255, may be used for either a new
  patient or an established patient. The inpatient
  consultation codes may also be used for places of
  service, such as nursing homes or a
  rehabilitation facility.
• When physicians code a consultation, they should
  follow the three Rs Medical Coding Jobs for
  Pharmacy Freshers

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• Request
• The consulting physician should receive a written
  request, including the reason for the
  consultation, from an appropriate source. Be sure
  it is documented properly and placed in the
  patient's medical record, as well as in the
  requesting physician's plan of care. If the
  physician is documenting in the chart by hand,
  the notes must be legible. If the notes are not
  legible, the visit will be treated as though
  there was no documentation and the visit did not
  happen, or the physicians will have their money
  taken back because the visit should not have been
  paid. Medical Coding Jobs for Pharmacy Freshers

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Request

• Before the consultation visit takes place,
  remember to follow this dual documentation
  process The requesting physician, as well as the
  consulting physician, should enclose the request
  and the reason for the consultation and document
  it in each of their charts.
• Medical Coding Jobs for Pharmacy Freshers

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Render

• Here are the criteria for rendering care
• The medical record needs to contain documentation
  of the consultants opinion, advice and (if
  applicable) any services that may have been
  ordered or performed. CPT guidelines state that a
  consultant can initiate diagnostic and/or
  therapeutic services to help formulate an
  opinion. CPT instructs that only one initial
  inpatient consultation should be billed per
  hospital admission. Medical Coding Jobs for
  Pharmacy Freshers

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Render

• If the transfer of care will be given to the
  consultant to treat the problem after an opinion
  is rendered, each visit after the consult should
  be reported as a subsequent hospital visit (CPT
  99231-99233). If not, care remains with the
  referring physician for treatment and follow-up.
• Medical Coding Jobs for Pharmacy Freshers

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Render

• If the consultant cant complete an opinion on
  the initial consult day, or if the referring
  physician requests the consultant to return later
  to provide additional advice, use follow-up
  inpatient consultation codes (99261-99263). You
  must thoroughly document additional consult days.
  Also, make sure you describe modifications to
  management options or advise on a new plan for
  patient care. Medical Coding Jobs for Pharmacy
  Freshers

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Report

• If the consulting physician does not share the
  patient's medical record with the requesting
  physician, then a letter must be sent to the
  requesting provider. In the case that the
  consulting physician does share the patient's
  medical record with the requesting provider, the
  report should be put on a shared record. The
  report should always include a thank-you letter
  for the consultation.
• Medical Coding Jobs for Pharmacy Freshers

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