Consults, same speacialty, different diagnosis, same group

michiboo

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Can anyone direct me to the guideline...

can you still bill a consult for same specialty, DIFFERENT dx, different provider , same group ??
 
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The consulting provider must have some expertise that the requesting provider lacks and that must be clearly documented along with the other elements of a consult. An example I've seen is a pain management practice where one doctor specializes in migraine treatment. What won't work is if a doctor is just asking a colleague for a second opinion.
 

cgaston

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The diagnosis is not a factor. Doctors of the same specialty in the same group are considered the same provider. If your doctors had different specialties but are in the same group you could bill separate E&M's but not in this case.

*edited a spelling error
 
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