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Thread: Consultation Coding ?s

  1. #1

    Post Consultation Coding ?s

    AAPC: Back to School
    Can a specialist bill a consultation if a patient is required to attend a seminar explaining the process for certain procedures before scheduling an appointment with the specialist?

    Would it be appropriate for the specialist to contact the primary care provider (PCP) after the patient attended the seminar to ask the PCP if they would like the specialist to see their patient in consultation to give their advice and opinion regarding which procedure option is most appropriate and then bill a consultation for this service?


  2. #2
    Join Date
    Apr 2007


    A consultation takes place when a provider requests another provider see their patient for a specific problem then give their opinion or advice on how the requesting provider should treat the problem.

    The situation you are describing is a transfer of care, which is coded as a new or established patient code depending on the patients status with the provider.

    I'm not sure what procedure you are dealing with but it sounds similar to the way they handle bariatric surgeries. The PCP doesn't do those, if they send a patient to a seminar and then a surgeon that does it is with the intent the surgeon deal with the problem, not tell the PCP how to deal with it. Even if the surgeon decides the patient should not have surgery and sends them back to the PCP, the intent is what drives a consult not the outcome. If you don't have the intent you can't ask for it and you can't bill a consult.

    Hope this helps,

    Laura, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    I agree with Laura, could not have said it better!

    Debra A. Mitchell, MSPH, CPC-H

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