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interoffice consults

  1. #1
    Location
    north seattle wa
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    103
    Default interoffice consults
    Medical Coding Books
    I need some clarification and I am hoping someone can help me with a link. We are having a discussion about whether a PA can request a consult from a physician in the same practice. The physician specialized in spines at the ortho practice. The PA will be a surgical assist to this doc and others.
    My concern with this is that a "consult is reported if the consulting physican has knowledge beyond the reqeusting professionals knowledge."
    Wouldn't a Physician always have more knowledge than a PA anyways????
    So would it have to be a PA to PA or Dr to Dr request to fit the definition below or can a PA send a pt to the Doc for a consult??


    Intragroup consults

    A physician or NPP in a group practice may report a consultation service if the consulting physician or 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 or NPPs within a group practice setting.


    Just want to make sure i am not running myself in circles here!

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    Just to make sure I understand your question. You are asking if a NPP (PA in this scenario) can request a consult from another provider? If so, Yes.

    An NPP may request and/or perform a consultation service within the scope of practice and licensure requirements for the NPP in the State where he/she practices and the requirements for physician collaboration and physician supervision are met;

    http://www.cms.hhs.gov/MLNMattersArt...ads/mm4215.pdf

  3. #3
    Location
    north seattle wa
    Posts
    103
    Default
    Thanks Rebecca. I appreciate the link. I just wanted to clarify that a PA can request a consult from a physician in the same practice. With everyone looking for every $ they can find these days, I want to make sure that we are on the straight and narrow!

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    I completley understand. I'm extremely anal when it comes to compliance.


  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default It depends
    I think your basic question holds a key here .... the PA will be assisting for the spinal surgery. That leads me to think that the patient presented with a problem that the PA is qualified to evaluate, but then if the PA feels surgery is warranted the PA "refers" the patient to the surgeon.

    Am I on the right track here?

    In this kind of scenario (as I outlined above) I would not code a consult for the surgeon. The visit would be an established patient visit.

    I know that some practices use PAs (or NPs) as a sort of first triage. Only those cases that cannot be completely managed by the allied health professional are sent on to the surgeons. These kinds of referrals "up the chain" aren't consults. The PA knows the patient needs the surgery and is sending the patient to the specialist who will do this.

    Remember that whether a service is a consultation is chiefly determined by the intent of the requesting provider. Is the PA truly seeking advice or opinion on a problem? Or is the PA referring the patient to the surgeon for surgery?

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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