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Need Consultation Help

  1. Default Need Consultation Help
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    Our compliance dept has informed a physician that he can not bill a consultation for a new problem because the patient was referred to him from the same physician for the first consultation. She is basing this information from the CPT book which states If an additional request for an opinion or advice regarding the same or a new problem is received from another physician or other appropriate source and documented in the medical record, the office consultation codes may be used again. Please help!!!

  2. #2
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    Ellenville, New York
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    Quote Originally Posted by aeacpc35 View Post
    Our compliance dept has informed a physician that he can not bill a consultation for a new problem because the patient was referred to him from the same physician for the first consultation. She is basing this information from the CPT book which states If an additional request for an opinion or advice regarding the same or a new problem is received from another physician or other appropriate source and documented in the medical record, the office consultation codes may be used again. Please help!!!
    Funny you mentioned your compliance department, as that is where I work for our organization and I have recieved the same question. I do not agree with this as long as the new problem is not due to a complication or late effect of the issue already being addressed. I believe that your compliance officer is interpreting the portion that says "another physician" to mean the second consultation request has to come from a different MD than the first. I take it to mean simply another physican than the one performing the service, like any other consulation request.

    Lance Smith, MPA, COC, CPMA, CEMC, RHIT, CCS-P, CHC, CHPC

    Director, Health Information Management
    HealthAlliance of the Hudson Valley
    Kingston, NY


    2016 Secretary
    Ellenville, NY Local Chapter

  3. #3
    Default
    I agree with Lance.

    The statement from CPT tells us that other providers may request additional consults for the same or new problem. I don't see any limitations for another consult by the same provider.

    Here is an article on consults: https://depts.washington.edu/uwpsite...ultations.html
    Consultant’s Services
    Consultations may be requested for new or established patients and for new or established problems. In outpatient settings a new consultation may be billed each time there is a new request for opinion or advice. The definition of the service as a consultation is based on the request and professional judgment of the requestor. The consultant does not need to consider whether a consultation should have been requested. It is the requestor who decides when more information or assistance is needed.

    In the inpatient setting only one consultation may be billed per specialty per admission, although the consultation may be made for new or established patients and also for new or established problems. If a subsequent consultation request is made to the same specialty during the same admission, even for a completely unrelated problem, this service must be billed as a subsequent hospital visit.


    Supercoder.com's appropriate source definition:
    An “appropriate source” can include another physician or other individual who can act on the advice/information the consulting physician provides. For instance, limited licensed practitioners, e.g., nurse practitioners or physician assistants, may request a consultation.

  4. Default Consultation Help
    Thank you both for your assistance.

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