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Referring within the same practice

  1. #1
    Reno Nevada
    Default Referring within the same practice
    Medical Coding Books
    I work for an Orthopaedic practice of 18 physicians, 3 PA's, and outpatient rehab. Each of our physician's specialize in a different area's of the body. Is it possible for our physician's to refer to each other and charge it as a consultation with the same diagnosis even though the patient is established under the same tax id number?
    Second question: Can our physician ask another physician within the practice to consult an established patient with a different a different diagnosis and charge a consultation?
    Thank you so much!
    Mackenzie CPC
    Last edited by kenzie44; 03-25-2009 at 12:29 PM.

  2. #2
    North Carolina

    We have orthopods that seek the opinion of our hand surgeon. Diagnosis shouldn't be an issue as long as long as the three R's are met (request, render, report).

    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

  3. #3
    Milwaukee WI
    Default Request opinion vs transfer care
    Rebecca is correct and (as always) has a great link for further info.

    I'm going to try to simplify with some examples.

    If the knee specialist is requesting the opinion of the spine specialist as to whether the patient has spinal issues that may be affecting the knee, then the spine specialist should probably be coding a consultation.

    If the knee specialist is referring the patient to the spine specialist because he(knee specialist) doesn't deal with spinal issues, then it's a transfer of care. And the proper code would be an established patient visit.

    Does that help clarify?

    F Tessa Bartels, CPC, CEMC

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