Results 1 to 3 of 3

multiple specialties for one provider

  1. #1
    Location
    Jefferson City, MO
    Posts
    33
    Question multiple specialties for one provider
    Exam Training Packages
    Some providers in the institution I work for have been told they can not request consults when it is in a specialty they possess. Here are some of the situations:
    Situation 1: A provider with two specialties, pulm and infectious disease, is caring for an patient in the critical care unit. The patient requires management of an infectious disease that the provider is unfamiliar with. Can he request another infectious disease provider with more experience/expertise to also see the patient? Can that provider then bill for the consultation (dependant on insurance carrier and documentation)?
    Situation 2: A pulmonary specialist is treating an patient in the hospital. This patient develops an infectious disease. Can the provider with dual specialties (pulm and infectious disease) be consulted to give management advise when the patient is already enlisted in one of the specialties he holds? Can that provider then bill for the consultation (depending on insurance carrier and documentation of course)?

    Any reference material would be highly appreciated as I try to educate the providers on the correct way to handle these type situations.

    Thank you.
    Katy

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by knulph View Post
    Some providers in the institution I work for have been told they can not request consults when it is in a specialty they possess. Here are some of the situations:
    Situation 1: A provider with two specialties, pulm and infectious disease, is caring for an patient in the critical care unit. The patient requires management of an infectious disease that the provider is unfamiliar with. Can he request another infectious disease provider with more experience/expertise to also see the patient? Can that provider then bill for the consultation (dependant on insurance carrier and documentation)?
    Situation 2: A pulmonary specialist is treating an patient in the hospital. This patient develops an infectious disease. Can the provider with dual specialties (pulm and infectious disease) be consulted to give management advise when the patient is already enlisted in one of the specialties he holds? Can that provider then bill for the consultation (depending on insurance carrier and documentation of course)?

    Any reference material would be highly appreciated as I try to educate the providers on the correct way to handle these type situations.

    Thank you.
    Katy
    Yes to both situations. The following information is in the instructions for Inpatient Consultations in Encoder Pro:

    "Consultations: Inpatient

    INCLUDES: A third-party mandated consultation

    All inpatient consultations include services provided in the hospital inpatient or partial hospital settings and nursing facilities

    Documentation of a request for a consultation from an appropriate source

    Documentation of the need for consultation in the patient's medical record

    One consultation by consultant per admission

    Provision by a physician or qualified nonphysician practitioner whose advice, opinion, recommendation, suggestion, direction, or counsel, etc. is requested for evaluating/treating a patient since that individual's expertise in a specific medical area is beyond the scope of knowledge of the requesting physician

    Provision of a written report of findings/recommendations from the consultant to the referring physician"
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
    Location
    Jefferson City, MO
    Posts
    33
    Default Thank you.
    Thank you. I thought it was okay but always like to have the supporting information to back up my thoughts before I go back to the provider. Also found some old presentations from a few of the MAC's that state it is okay within one specialty as long as it is medically necessary.

    Again, thank you.

    Katy

Similar Threads

  1. Same provider has 2 specialties.
    By 1abbynskye in forum Compliance General Discussion
    Replies: 1
    Last Post: 07-20-2012, 01:36 PM
  2. Multiple Provider inpatient visits on same day
    By MSUEEMBRY in forum General Surgery
    Replies: 2
    Last Post: 01-17-2012, 09:22 AM
  3. CPC, 4+ Yrs Exp in Multiple Specialties
    By peachygirl in forum Resume Postings
    Replies: 0
    Last Post: 05-20-2011, 03:55 AM
  4. Contract coders, Multiple specialties and E/M
    By babrede in forum Employment General Discussion
    Replies: 2
    Last Post: 04-12-2011, 12:51 PM
  5. specialties
    By kempistyj in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-24-2010, 12:19 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.