consult question

[Patricia Ferrer]

Can we bill consult codes when one provider in our practice sends a patient to another provider within our practice? Thanks for the help.

 

[armen]

Can we bill consult codes when one provider in our practice sends a patient to another provider within our practice? Thanks for the help.

I would bill it. Since it is a different provider there should be no problems. We have similar situation in our practice. Patient is post op for one provider but we bill office visit for another provider. The same tax id, the same office, the same day.

 

[Patty S.]

If they are different specialties, they may. They each have to have different specialty credentials. So, it all depends upon that. You also cannot bill a Medicare patient a consult. Hope that helps-

 

[lfreemanbaker]

Hey Patty,

Many payors guidelines show that consults may be paid when a opinion or consult is requested, even in the case of physicians in the same group practice. There is an article on Trailblazer's website that speaks of this. It says "Payment may be made for a consultation if one physician or qualified NPP in a group practice requests a consultation from another physician in the same group practice when the consulting physician or qualified NPP has expertise in a specific medical area beyond the requesting professional’s knowledge. A consultation service should not be reported on every patient as a routine practice between physicians and qualified NPPs within a group practice setting".
Maybe this article would be helpful: http://www.trailblazerhealth.com/Publications/Job Aid/consultation services job aid.pdf

 

[Patricia Ferrer]

Thanks for the help.