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Thread: Consult

  1. #1
    Join Date
    Apr 2007

    Default Consult

    AAPC: Back to School
    Can a dr within the same practice as a nurse practioner charge for a consult of a patient she sent for him to see?

  2. #2
    Join Date
    Apr 2007


    Yes if guidelines are met. This is directly from the Medicare Claims Processing Manual, Chapter 12, 30.6.10 paragraph E, Consultations Requested by Members of Same Group, which states

    "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."

    Hope this helps.

  3. #3
    Join Date
    Apr 2007
    Boston, MA


    Ask this question first: why did the NP send the patient to the MD? For advice or for treatment? If it is for advice and all the consult requirements are met, then yes, you may use the consult codes. Otherwise you cannot.

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