While this particular scenario may seem a little muddy as far as the intent, someone I greatly admire shared this with me.
There are still many cases where the ED physician is asking for an opinion, usually regarding whether the patientâ€™s presenting problem is related to a certain body system that pertains to a certain specialty. For example, chest pain can be caused by several thingsâ€”respiratory distress, coronary pathology, hiatal hernia, etc., each of which is handled by a physician of a different specialty. The ED provider may not feel comfortable making the final dx, and so will make their best guess as to which one is the likeliest candidate and usually call that specialty in first to provide an opinion. Letâ€™s say the ED provider calls in Cardiology to provide an opinion as to whether or not the problem is a cardiological one. The ED provider does not KNOW that the Cardiology provider coming to the ED as a result of their request will be taking over because they donâ€™t even know yet if the patientâ€™s problem is cardiological in natureâ€”thatâ€™s the whole point of asking for the cardiological opinion/consult. Letâ€™s say in this situation that the cardiologist consultant provides the opinion that the patientâ€™s problem is NOT in fact related to any coronary pathology that they can find. At this point, the ED provider may choose to discharge the patient, order addâ€™l tests, or consult another specialty.
So because of the fact that ED providers often request opinions from specialists in order to rule out certain conditions and to help them determine who they should call or consult next, the services they request will often be accurately billed by the requested provider as a consult.
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