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Thread: consult question

  1. #1

    Question consult question

    AAPC: Back to School
    We have a new physician who is asking if they see a patient of another doctor (at the same practice) for say a female pap, pevlic and breast exam because this doctor is a female & the normal doctor is a male..can she charge a the visit as a consult? My feeling and opinion is "no" as they are credentialed the same and there is not a particular medical problem for the use of a "consult" code. Am I correct? Does anybody know?

  2. #2

    Default Consult

    By definition of a consult, NO.

  3. #3
    Join Date
    Apr 2007
    Loma Linda,CA


    I would say no since our CPT books state "A consultation is a type of service provided by a physician whose opinion or advice regarding E&M of a specific problem is requested by another physican or other appropriate source. "
    Due to the sex of the physican is no reason to bill a consult. I would not image the doctor would write a written request for a consult due to his or her own sex. I believe this is not a valid reason.They can bill a preventive visit if that is preformed otherwise it would be an established patient 99211-99215.
    However this is just my thoughts.

  4. #4


    That was my opinion, but had never had that question posed to me. Thanks!

  5. #5
    Join Date
    Apr 2007
    Woodbridge, VA


    Also, let's say the first doctor had requested a consult from another physician within the same group, the consultant must have expertise in a specific medical area beyond the requesting professional's knowledge. This is per Medicare's guidelines.

    Zaida, CPC

  6. #6
    Join Date
    Apr 2007
    North Carolina


    Nicely pointed out Zaida. An example of this would be in the Orthopedic arena. Both may be Orthopedic surgeons but one has a sub-specialty in Hand Surgery.

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