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Thread: 2 doctors, same specialty,consult different dates, different DX

  1. #1

    Default 2 doctors, same specialty,consult different dates, different DX

    AAPC: Back to School

    Can the following be billed:

    You know I have 3 providers that share same specialty so my question is if one dr see’s pt for a consult on 09/11 can I bill another consult for another dr on a different date? Different dx’s. yes, right?

  2. #2
    Join Date
    Apr 2007


    They can if it is outpatient.

    Inpatient is only 1 consult per group/specialty per admission, wouldn't matter if it was for another issue.

    Of course I am quoting CMS guidelines, commercial carriers could be different.

    Laura, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Grand Rapids, MI


    You didn't say if it was inpatient or outpatient.

  4. #4
    Join Date
    Apr 2007


    for inpatient it is one consultation per visit.
    In outpatient setting though, here is what I copied and pasted from CMS.
    hope this helps
    Also, physicians and qualified NPPs need to be aware that:

    Medicare does not recognize CPT code 99211, a minimal service, for a consultation service as it would not meet the consultation criteria;

    An initial inpatient consultation will be reported only once per consultant per patient per facility admission;

    In an office or outpatient setting, if an additional request for a consultation, regarding the same or a new problem with the same patient, is received from the same or another physician or qualified NPP and documented in the medical record, the Office or Other Outpatient Consultation codes may be used again

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