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Consultation by PCP

  1. #1
    Question Consultation by PCP
    Exam Training Packages
    Can the PCP bill for a consultation when seeing the patient for a surgical clearance?

  2. #2
    Nashville AAPC Chapter
    Yes they can, a consultation is a request for an opinion. Medical clearance is an opinion as to whether they are fit enough to have the procedure performed. They must follow the three R's of a consultation though.
    1. Receive a request (documented in the chart that a formal request for an opinion is made)
    2. Recommendations: list of findings of the exam.
    3. Report: send a report back to the requesting physician.

    Caveat: I see many physicians over bill in this area and bill level 5's when the surgery being performed is not high risk. Example: If the patient is getting a knee replacement, the risk is moderate and probably warrants a level 4 consult. If the patient is going to have open heart surgery, this would warrant probably a level 5 consult. I see EKG's ordered as standard protocol whether or not the patient has heart issues and this is abuse of the situation.

    But every encounter is open to interpretation.

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