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"other appropriate source" for consult request

  1. Default "other appropriate source" for consult request
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    Is a college athletic trainer considered an "appropriate" source for a consultation request? Our physician sees athletes from a local college that have been sent here by the Trainers for an injury and our physician feels that this is a consultation. His opinion is requested by the trainer and the patient is treated and then the report is sent back to the college trainer. Our billing office says since there is not a NPI number for the trainer that we cannot bill this as a consult...but what is an other "appropriate source"?? I have seen online while searching this topic that a lawyer or insurance company is considered an "other appropriate source"...they don't have NPI numbers right? How would the referring source be documented on the claim forms without an NPI?

  2. Default
    In my CPT manual, under the Consultation Visits section, it says "...or other appropriate source (e.g. physician assistant, nurse practitioner, doctor of chiropractic, physical therapist, occupational therapist, speech-language pathologist, psychologist, social worker, lawyer, or insurance company)...". I agree that a school trainer is not considered an "appropriate source" based on what's available to us in the CPT manual.
    The definition of a Consult is the request from one physician to another to get his opinion only so the 1st physician knows what direction to go in for his patient's care. If the Trainer is sending the student/athlete to your Physician for an opinion the Trainer really qualified to take on the care of that patient's injury when that athlete comes back with that opinion? No...this Trainer is sending his athlete to your Physician for care, not for an opinion only.

    Last edited by JMeggett; 11-11-2010 at 09:23 AM.

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