READER QUESTIONS:
Get Intraoffice Consults in Line
Published on Mon Aug 17, 2009
Question: I have an ob-gyn practice that wants to bill consults within their same group. They all share the same tax ID but have different sub-specialties. They want to refer patients to each other and then bill out consults. Is this possible? If so, could you point me to the source document? Georgia Subscriber Answer: Yes, they can -- provided the following situations are true: • The ob-gyn whose advice the other physician requests has more expertise than the initial physician. • The visit meets the standard criteria for consults. Consult criteria: The Medicare Claims Processing Manual, Chapter 12, Section 30.6.10, states, "A consultation ... is provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician." But you shouldn't just look at that statement and assume that every request for an opinion warrants the consult codes (99241-99255). The MCPM goes [...]
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