Wiki when to bill a consult

[ChristineA]

We have two physicians who left our practice last October. We still cover for each other for inpatient's in the hospital setting and one of our physicians is asked to see patient's for his opinion on EUS's. We have one physician who is asked to see patient's regarding EUS (as he is the only one in town who does them) and if he thinks a patient is going to need one or not and he performs a consult or report back to the physician that requested his service which ordering physician of the EUS may have been one of the physician who left our practice last year can we bill a consult code for this and if not can we bill a follow up for our physician going in and giving his opinion?
Is there any specific rule if a GI doctor consults another GI doctor but they are from a different practice but they used to be together or cross cover for each other with inpatients.
Thank-you.

 

[cgaston]

Doctors of the same specialty can request a consultation from one another. Doctors in the same group can request them too! The key factor for billing for a Consultation is documenting a request from one physician to the other and the follow up report in the medical record.

From the CPT:

"The written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source. The Consultant's opinion and any services that were ordered or performed must also be documented in the patient's medical record and communicated by written report to the requesting physician or other appropriate source".


So Doc A needs to note in the patient's record that he wants Doc B to provide his opinion regarding Patient C. Doc B needs to note that he saw Patient C at Doc A's request and send a report to Doc A with his findings.

There are no restrictions regarding Specialties, Groups, etc.