multiple specialties for one provider

knulph

Networker
Messages
33
Location
Jefferson City, MO
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Some providers in the institution I work for have been told they can not request consults when it is in a specialty they possess. Here are some of the situations:
Situation 1: A provider with two specialties, pulm and infectious disease, is caring for an patient in the critical care unit. The patient requires management of an infectious disease that the provider is unfamiliar with. Can he request another infectious disease provider with more experience/expertise to also see the patient? Can that provider then bill for the consultation (dependant on insurance carrier and documentation)?
Situation 2: A pulmonary specialist is treating an patient in the hospital. This patient develops an infectious disease. Can the provider with dual specialties (pulm and infectious disease) be consulted to give management advise when the patient is already enlisted in one of the specialties he holds? Can that provider then bill for the consultation (depending on insurance carrier and documentation of course)?

Any reference material would be highly appreciated as I try to educate the providers on the correct way to handle these type situations.

Thank you.
Katy
 

ajs

True Blue
Local Chapter Officer
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Tacoma, WA
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Some providers in the institution I work for have been told they can not request consults when it is in a specialty they possess. Here are some of the situations:
Situation 1: A provider with two specialties, pulm and infectious disease, is caring for an patient in the critical care unit. The patient requires management of an infectious disease that the provider is unfamiliar with. Can he request another infectious disease provider with more experience/expertise to also see the patient? Can that provider then bill for the consultation (dependant on insurance carrier and documentation)?
Situation 2: A pulmonary specialist is treating an patient in the hospital. This patient develops an infectious disease. Can the provider with dual specialties (pulm and infectious disease) be consulted to give management advise when the patient is already enlisted in one of the specialties he holds? Can that provider then bill for the consultation (depending on insurance carrier and documentation of course)?

Any reference material would be highly appreciated as I try to educate the providers on the correct way to handle these type situations.

Thank you.
Katy
Yes to both situations. The following information is in the instructions for Inpatient Consultations in Encoder Pro:

"Consultations: Inpatient

INCLUDES: A third-party mandated consultation

All inpatient consultations include services provided in the hospital inpatient or partial hospital settings and nursing facilities

Documentation of a request for a consultation from an appropriate source

Documentation of the need for consultation in the patient's medical record

One consultation by consultant per admission

Provision by a physician or qualified nonphysician practitioner whose advice, opinion, recommendation, suggestion, direction, or counsel, etc. is requested for evaluating/treating a patient since that individual's expertise in a specific medical area is beyond the scope of knowledge of the requesting physician

Provision of a written report of findings/recommendations from the consultant to the referring physician"
 

knulph

Networker
Messages
33
Location
Jefferson City, MO
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Thank you.

Thank you. I thought it was okay but always like to have the supporting information to back up my thoughts before I go back to the provider. Also found some old presentations from a few of the MAC's that state it is okay within one specialty as long as it is medically necessary.

Again, thank you.

Katy
 
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