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subspecialty consult within practice

  1. Default subspecialty consult within practice
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    In an orthopedic practice, there are doctors with subspecialties, say hand or foot, IF Dr Hand refers patient to Dr Foot, can Dr Foot bill for a consultation ? This question arises from internal audit for 2009 so the new rules do not apply. Where can I find rules to prove or disprove that you can do this other than the e/m guidelines in the CPT book?

  2. Default
    Quote Originally Posted by ncrevello@myihbs.com View Post
    In an orthopedic practice, there are doctors with subspecialties, say hand or foot, IF Dr Hand refers patient to Dr Foot, can Dr Foot bill for a consultation ? This question arises from internal audit for 2009 so the new rules do not apply. Where can I find rules to prove or disprove that you can do this other than the e/m guidelines in the CPT book?
    I, too, would like to know the answer to this! And is it a true Consultation if Dr Hand knows that Dr Foot isn't going to just give his opinion and send patient back to Dr Hand...but keep the patient for that foot problem and treat it? I realize I'm asking now about the TOC new rules....but wouldn't it be Transfer of Care - Established Patient if Dr Foot takes over care for that foot problem? OR...is it true that due to that subspecialty Dr Foot can get a Consultation charge whether he keeps patient or not. ? Of course Dr Hand and Dr Foot want to get as many Consults as they're allowed....but I'm confused as to when it's legit or not.
    Jenna

  3. #3
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    Yes, doctors of the same specialty can consult one another. You will most likely have to send in documentation to prove that is what really happened.

    In the case of a hand ortho and a foot ortho the likelyhood of a consult under the CMS rules prior to 2010 seems highly improbable to me.

    I don't have the link but the following comes from an MLN MM4215 Effective 1/1/06.


    Medicare will pay for a consultation if a physician or qualified NPP in a group practice requests a consultation from another physician or qualified NPP in the same group practice when the consulting physician or qualified NPP has expertise in a specific medical area beyond the requesting professional's knowledge;

    http://www.cms.gov/transmittals/downloads/R788CP.pdf

    Hope this helps,

    Laura, CPC, CPMA, CEMC

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