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Thread: NPP providing consults

  1. #1
    Join Date
    Apr 2007

    Question NPP providing consults

    AAPC: Back to School
    Ok, in the state of Michigan (and many others) PAs and NPs can do consults.

    If they reference in their plan that they have discussed the case with the doctor and the doctor agrees with the plan does that knock it out of the consult range since consults are not split/shared services?

    I'm inclined to say it does since the whole point of the consult is the provider being consulted is going to give you their expert opinion, not be the middle man for someone elses expert opinion.

    If anyone has documentation to support this either way I would greatly appreciate it.

    The visits in question involve a PA doing the initial eval of the patient prior to the doctor doing or not doing surgery. Many are not consults but clear transfers of care. Some could be argued either way and that is why I am asking about the doctors invovlement, even if only referenced.


    Laura, CPC, CPMA, CEMC

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default MDM Data points

    Any provider (including an NP or PA) can choose to discuss a case with another healthcare professional ... they get 2 data points for this.

    The consult still goes out under the NP/PA's name.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Carmel, New York


    I don't see how discussing the case with the doctor would "disqualify" the NPP from being able to charge for a consultation. As long as that is still the work and conclusion of the NPP, the doctor's contribution is from the discussion with the NPP. I would count that as a data element and bill out as a consult (unless a MCR patient - don't want to go THERE!)

  4. #4
    Join Date
    Apr 2007


    Thanks for responding.

    This is a touchy subject for us. The consult is actually requested of the doctor but they send a PA to do it. Some carriers have told me that right there disqualifies use of the consult code since the requested provider did not actually provide the service.

    My thinking is if the provider doing the service can't finalize the plan without going to the provider they actually requested to see the patient in the first place, this seems more of an incident to or split/shared visit. Which is not acceptable for consults.

    Laura, CPC, CPMA, CEMC

  5. #5
    Join Date
    Apr 2007
    Columbia, MO


    remember for a shared service the physician must have a face to face encounter with the patient on the same day and have his own encounter note. Signing off on the NPP documentation is not sufficient to bill under the physician. But I agree the consult was not requested for this provider so it cannot be a consult.

    Debra A. Mitchell, MSPH, CPC-H

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