Free Consultations

The question regarding what you can do and cannot do during a free consultation has come back to us. As many practices offer some sort of free consultation as a marketing tool, we decided to readdress this question.

Medicare has some guidelines of which one should be aware. Medicare has significant issues with anything that can look like an inducement. Essentially, are you giving something away to entice the patient to see you? The problem with the free consult is if you are giving away your time and expertise, this can be considered an inducement. Medicare is fine with education of a patient. Ordering tests and/or placing a patient in stockings means you have made a diagnostic impression of some sort. In order to do that, you had to provide medical services. You have provided something of value. Some commercial plans likewise have non-inducement clauses in their Provider Manual.

The CPT manual for all things coding also has some elements for your consideration. Your initial visit, one of the 9920X codes, is billed when you first see the patient and determine a diagnosis and plan. If you are ordering tests or conservative therapy during a free consult, you have already determined a diagnosis and initiated a plan. Billing a 9920X code a week later when you do the formal History and Physical and a much more complete work up of the patient could be considered fraudulent as the patient is no longer ‘new.’ A very complete reviewer could determine that the free consult was essentially your new patient visit (99202) and that the subsequent more complete work up of the patient was an existing patient visit (9921X).

In short, we recommend that the free consult really be an educational visit. Coach the patient that they will have five minutes of the great doctor’s time. The patient can be asked to make a list of questions they would like answered regarding varicose veins and the treatment of same. This invests the patient into the process and highlights the educational nature of this visit.

Try to avoid being trapped into a direct clinical discussion with the patient. One way to sidestep this is to note that a formal clinical review would need to be scheduled with your office staff. We strongly recommend against ordering conservative therapy and/or diagnostic testing until you actually do a formal review of the patient’s condition.

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