Dermatology Coding Alert

Published on Mon Apr 10, 2006 PDF

Question: Parents brought their child to our office to discuss her acne. Considering that one of CPT's consultation criteria is "requested by another physician or other appropriate source," what constitutes an "appropriate source"? Must this person be a medical professional, or could she be a teacher?


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Answer: Although CPT 2006 no longer includes confirmatory consult codes, the old codes established that a parent could request a consultation with a physician on behalf of his child and would therefore qualify as an "appropriate source." Because of this, many coders believe that people who are not medical professionals--such as parents or teachers--can count as an appropriate source. Therefore, you can only code the visit as a consultation (99241-99245, Office consultation for a new or established patient ...) if the physician meets all the consultation criteria.