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Thread: Consultation for same specialty, same diagnosis, different doc

  1. #1

    Default Consultation for same specialty, same diagnosis, different doc

    AAPC: Back to School
    Can anyone point me to documentation that would allow or disallow a physician to bill a consult for a patient who has already been seen by another physician in the same practice and specialty within a few months? (Also same diagnosis) Thank you!

  2. #2
    Join Date
    Apr 2007


    I work for a specialty, and we bill return visits on patients that are seen by different docs, but within our group. Im sure its in the guidlines as well . I believe the criteria for a new patient is not seen by same group within three years.

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    if it is the same specialty and the same diagnosis, then how can you have a consult? Also you need to be careful about requesting consults of providers within your own group. You request a consult for a specialist for an issue than needs a solution not for a particular doctor. The patient needs to decide which doctor of that specialty they will see.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4


    Debra...that was my point to one of our coders. That is why I need to find documentation to show her. She thinks it is okay to bill a second consult, but I don't, that's why I was asking for documentation help. Thank you for your opinion though.

  5. #5
    Join Date
    Apr 2007
    Milwaukee WI

    Default It depends

    This will depend on the circumstances.

    For example ... patient sent to Ortho doc for consultation on left knee pain in March. Consult performed, conservative treatment recommended, patient released back to PCP. In June patient still having knee pain, so PCP send patient back to Ortho doc for another consultation. (Or maybe this time it's the RIGHT knee ... ICD9 doesn't distinguish between lt and right ... ICD10 will fix that.)

    We really would need more specific information and the documentation trail to tell for certain whether your second visit is another consultation or an established patient visit.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. #6

    Default Consultation for same specialty, same dx, different MD

    I have a dermatology pt that was seen for spot on cheek, 1st Derm MD performs biopsy and determination BCC and request consult to Derm MD #2 for MOHS? Can Derm #2 bill consult for this visit?
    Dawn Smith, CPC

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