cpccoder2008
True Blue
We do the billing for physician's at a hospital. We have a wound care NP who wants to bill Consults for patients that are sent to her from surgery. She was told she cannot bill consults because the reffering physician's is her supervisor and she falls under the surgery specialty. She has her own number and does her own billing. I came across this while reading the coding edge and wanted a little more feedback on it. Can someone tell me if this would apply to our situation and that she can indeed bill consults ? Thanks
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
30.6.10 - Consultation Services (Codes 99241 - 99255)
E. Consultations Requested by Members of Same Group
Carriers pay 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 shall not be reported on every patient as a routine practice between physicians and qualified NPPs within a group practice setting.
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
30.6.10 - Consultation Services (Codes 99241 - 99255)
E. Consultations Requested by Members of Same Group
Carriers pay 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 shall not be reported on every patient as a routine practice between physicians and qualified NPPs within a group practice setting.