Results 1 to 6 of 6

consult question

  1. Question consult question
    Medical Coding Books
    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. Default Consult
    By definition of a consult, NO.

  3. #3
    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. Default
    That was my opinion, but had never had that question posed to me. Thanks!

  5. #5
    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
    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.

Similar Threads

  1. Consult Question
    By jflynn in forum E/M
    Replies: 0
    Last Post: 08-05-2015, 08:33 AM
  2. Consult Question
    By Jtk625 in forum Billing/Reimbursement
    Replies: 3
    Last Post: 05-17-2013, 06:51 AM
  3. Consult question
    By in forum Compliance General Discussion
    Replies: 4
    Last Post: 03-30-2012, 01:40 PM
  4. Help!!-consult question
    By heathergirl in forum General Surgery
    Replies: 2
    Last Post: 11-05-2008, 02:37 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.