Wiki Referring PCP Needed??

[pajohnson]

When billing a consult code and we have no referring provider, can we still bill the consult code? Some of my office workers are having a difference of opinion on this. I was hoping to get some clarification.
We are a specialty neurology office.

Thanks for any help

 

[mitchellde]

you cannot have a consult without a referring provider, if the patient self refers then it is not a consult.

 

[Monika Liddle]

Consult Codes

In order to bill a consult you need to meet the necessary requirements:

Request - a request and the reason for consultation must be documented in the patient's record. (no requesting provider you can not bill a consult)

Render - the consultant renders an E&M service to the patient related to the specified problem

Respond - the consultant responds to the requesting provider by preparing a written report of the providers findings and recommendations.

 

[pajohnson]

Thank you both for your feedback. This will clear up any confusion that my co-workers had.
Thanks Again!!

 

[Practice Coder2011]

You cannot bill a consultation without a referring physician. Especially when a certain insurance is in definite need..otherwise billing will be denied.