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Thread: Need advice on consultation visits

  1. #1

    Exclamation Need advice on consultation visits

    AAPC: Back to School
    I need to know what the "rules" are when dealing with in office consultation requests from another provider...I work for a dermatology practice.

    Can we bill for a consult, if we receive a referral stating, "consult and treat"?
    This would be an established patient visit to us with a "new" problem that their primary care sent to have looked at? I do not see in the Medicare guidelines that state, the patient would have to be new to the practice in order for it to be ok to bill for a consult. I really need clarification on this, please help!

    Much appreciated!


  2. #2
    Join Date
    Apr 2007
    Madison Area Chapter in Madison WI


    You need three pieces to support a consultation. They are referred to as the 3 Rs. Request, Render, and Response
    1. A request for consultation from another provider
    2. Render your opinion on the care of the patient.
    3. Respond back to the "requesting" provider.

    It doesn't matter if the patient is new or established. In addition, the consulting provider can treat the patient and it will still be a consultation as long as the 3Rs are met.

    You should be able to find this information in CPT.
    Happy Coding, Claudia

    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    ccrsconsulting.com - website

  3. #3


    I agree with Claudia, the 3 R's must be met.
    ~Amy, CPC, CPMA, CEMC~

  4. #4


    Thanks so much...I did see in the CPT book regarding consultations, I just need to see what my fellow coders thought....:0)

    Much appreciated ladies!


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