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Consults from a consulted DR

  1. #1
    Default Consults from a consulted DR
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    It seems like a dumb question. It also seems like I should know this, but I'm drawing blank.

    Can a physician, who is consulting on a patient, request a consult from another physician? And, if yes, can the physician do so without contacting the patient's primary physician?

  2. #2
    I don't see why not... there is nothing in the descriptor that says the requesting physician must be a primary care doctor. As to the second part of your question, that depends on the insurance. Many require preauthorization to see a specialist.

  3. #3
    In theory I agree there is nothing stating a doctor that was brought in as a consultant can't also request consults.

    The problem I have with this is the fact that to be a consultation and not a transfer of care the provider requesting the consult must intend to continue treating the problem. This is generally not what happens when a specialists calls in another specialist. My surgeons do this all the time, they are called in to evaluate a patient for say a lung mass, determine that this patient is not a surgical canidate and send them onto an oncologist. They are done. They have no intention of treating that issue again. This is not a consult. Is it billed that way, good chance it is. Is it correct, no.

    This used to be a CMS issue, as of 2010 with the added verbiage from AMA to the book it is a CPT issue that will affect every payer still allowing consults.

    Laura, CPC, CEMC

  4. #4
    ^^ that is true... the rest of the requirements for a consult must be met. I was only adressing the very specific question of whether it was possible for a specialist to request a consult, not whether it was something commonly done. Like Laura, I would guess that most specialists bringing in another specialist are actually handing off the care. That would not qualify as a consult.

  5. #5
    In theory a consulting provider can ask for another consult. You really have to look at the documentation and see how the scenario unfolds. If I may use an example: Dr. A (the PCP) sends the patient for an opinion to Dr. B, a cardiologist. The patient's issues are quite specific and Dr. B feels that his colleague, Dr. C - another cardiologist, specialising - for example - in EP procedures, is more qualified to better advise on this issue because the patients issues fall into Dr. C's expertise within the field of cardiology. In such a setting it would be realistic for a consultant to request another consult. In theory (again) Dr. C would send a report to Dr. B who would be using this information to give the requested opinion to Dr. A who will continue treating the patient. It is also possible to decide after the consult that Dr. C or Dr. B will take on the care of the patient for the cardiac problem. The intent however was for an opinion and therefore each consult has merit - in theory. If this is a real case it would be feasible to review the insurance policies for conditions and pre-auth requirements.
    Karolina, CPC, CPMA, CEMC

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