General Surgery Coding Alert

Question: How specific must a consult request be? I know there must be a specific reason for the request, but does the request have to specify by name the physician who should provide the consult?


Georgia Subscriber

Answer: Although a requesting physician certainly may request a consult from a particular specialist, it isn't required. Neither AMA nor CMS guidelines state that the consultation request specifically name the physician who provides the consult.

Theoretically, as long as the request specifies the problem, any physician with the expertise to provide his opinion may provide the consultation service. The requesting physician might only send a patient to a particular practice, for instance, rather than to an individual physician, for consultation.