Wiki Doctor Consulting A Doctor Of Different Specialty In Same Hospital - MDM

Hello,

When a doctor consults with another doctor of a different specialty within the same hospital, and the consultation isn't reported separately with a consultation code, does it count towards Category 3, "discussion of management with other QHP?" Without a consultation code, both doctors could count the discussion towards their own MDM, so is the one who consults another doctor the one that doesn't get counted?

Hi there, if I understand your question: If both providers are reporting an E/M visit and the discussion is relevant to both providers' MDM for that encounter then they could both count the discussion one time.

I recommend reviewing the relevant definitions, including external physician/QHP and discussion in the CPT manual.

I hope I am understanding the question correctly. Presuming that both physicians are directly providing care to the patient, each is using the discussion to inform medical decision-making so each would document their discussion and count that work towards the level of MDM.
If this were a consultation between physicians and/or other qualified health care professional (QHP) of the same practice and same specialty, then the time and data analysis would count toward only one individual's service because there would be no external physician or other QHP.

Cindy

Hello,

This is referring to Category 3 of amount and/or complexity of data to be reviewed and analyzed "discussion of management or test interpretation."

For example, if a physician meets (3) from Category 1 only, the MDM would be moderate. If they meet (3) from Category 1 and also (1) from Category 3 by discussing management with another QHP, the MDM would be extensive.
There are two points to the question:
1. Are physicians of different specialties within the same hospital counted as "other QHPs" as per CPT guidelines (page 12) "an external physician or other qualified health care professional who is not in the same group practice or is of a different specialty or subspecialty [doesn't state within same hospital]?" Can two doctors of two different specialties count as "other QHP" when they work in the same hospital?
2. Which doctor gets the MDM counted for their data to be reviewed? If both of the doctors get an E/M code for their services, the concept of double dipping only allows one of them to count it. The doctor who is consulted and provides the advice should get the MDM.

Thank you.

1. Yes, because they're different specialties. Their employer doesn't matter.
2. Double-dipping isn't an issue here. Who can count it will depend on who applies the discussion to their MDM for the encounter. If Dr A and Dr B have a discussion and both doctors apply that information to their MDM for their visits, they would both count it. If only Dr. A uses the information from the discussion only Dr. A would count it. If the discussion wasn't applied toward MDM at all neither doctor would count it.

Hello,

Thank you.