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Thread: Consults

  1. #1
    Join Date
    Apr 2007

    Question Consults

    AAPC: Back to School
    Our Risk Cancer Genetics Counselors is asking for one of our Breast General Surgeons to consult on this patient. My question is: Can a non-physician send a patient to a physician in our practice, and can that physician bill a consult?

    Per CPT book:
    A consultation is a type of E/M service provided by a physician at the request of another physician or appropriate sourceto either recommend care for a specific condition or problem or to determine whether to accept responsibility for ongoing management of the pts entire case or for the care of a specific condition or problem.

    Is our Risk Cancer Genetic Counselors considered an appropriate source??
    Kristen Richard, CPC

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default CPT vs CMS

    Well, per CPT it would seem that the genetic counselor may be an appropriate source. BUT ... CMS (and every other carrier) requires an NPI number for the requesting provider, so unless your genetic counselor has an NPI, I don't think you'll be able to code a consultation.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3


    Per our consultant -other appropriate sources can be the following: physician assistant, nurse practitioner, doctor of chiropractic, physical therapist, occupational therapist, speech-language pathologist, psychologist, social worker, lawyer, or insurance company. In my opinion CCG counselors would be considered an appropriate source.

    FBartessa- I am curious as to why an appropriate source would need an NPI number? What if this is a mandated consultation by a third party insurance or lawyer? And most social workers are employed by the hospital and would not necessarily have an NPI number. I am looking forward to your answer. (I am hoping I can learn something new )
    Last edited by 1071471; 05-07-2010 at 05:33 PM. Reason: Added opinion to question asked re: CCG counselors considered appropriate source

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