Consultation Visit?


Beechhurst, NY
Best answers
Hi All,
I have an Infectious Disease Provider billing Consultations for visits that are Referred by an Internal Medicine Nurse Practitioner and both of them are working in the same clinic and the follow-up are done by the NP and sometimes the ID provider will do the follow-up visits?
1.) If Infectious Disease and Internal Medicine are two different Specialties?
2.) Can the Infectious Disease Provider bill for Consultation?

Mid level providers are not designated to any one specialty so the NP would just be an NP not an infectious disease NP as far as credentialing, licensure, and taxonomy goes. If these two providers are under the same tax ID# then the infectious disease physician should not be billing NP referrals as consults.

If the internal medicine physician requested an ID consult then the ID physician would be warranted in billing a consult code.
Hi Nicole,
The NP has her own Internal Medicine Tax ID number and when I asked the ID Provider he does the 3 R"s. So do you think the ID provider could bill for his consult services?

Thank again..
So the NP is NOT under the same tax ID# as the ID physician? Not Medicare provider #, NPI #, Upin, legacy, or any other numbers.

They would have to have completely different business tax ID #'s.

That is what you need to know in order to determine if the NP's referral can be billed as a consult by your ID physician. The only time and "inter-office" consult can be billed is between two separate specialties that are recognized as two different specialties by taxonomy codes, licensure, board certifications etc.
Yes, indeed they have 2 different taxonomy codes and has their own Tax ID # in which the NP also is credentialed with Medicare,Medicaid..etc.
And for one last question: Because sometimes when the NP refers the patient to the ID provider and the ID provider will be the one to take over the follow-up visits, DEFINITELY
the ID can't bill for the consultation visit? RIGHT or WRONG? many THANKS..
So if this NP has a different tax ID# she is employed by a different company but working in your office? Taxonomy is not what makes the difference in this scenario, employer (thus two different tax ID#s) does.

If the NP requests a consult for something that after the ID physician renders an opinion on she could potentially take back the patient and manage herself than that would be a consult for the ID physician. If the NP sent the patient to the ID physician knowing the problem must be handled by the ID physician and there is no intent for the NP to take back over after the ID physician renders an opinion that is a transfer of care and the ID physician would not bill a consult.
Both of them are working in ONE clinic with the SAME employer..thanks Nicole for your prompt reply and attention is highly appreciated..God bless..