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PA and Consultation

  1. Default PA and Consultation
    Exam Training Packages
    Can a MD bill for a consultation if the patient was referred by a Physician's Assistant?


  2. #2
    The referral for consult is so that the Referring MD can determine a plan of care for one or more of the patient's condition's & is asking the MD they refer to, for either their "speciality" on that condition or other options on how to care for their patient.
    Since a PA cannot bill for an evaluation, they cannot develop the patient's plan of care in the first place, so a referral should alway's come from the patient's MD.

    Best thing to do is resend your MD's Consult Request Form or the Order send by the PA and ask the PA's, M.D. to sign the form in addition to the PA to be able to bill for that one time consult with the patient and bill the MD as the Ref. Provider not the PA.

    Hope that is clear b/c not the easiest answer to write out.



  3. #3
    We allow our PAs to request consults but they cannot perform one.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  4. #4
    Milwaukee WI
    Default Yes
    Please read the guidelines ... 2008 CPT Professional edition, pg 14 ...
    A consultation .... is requested by another physician or other appropriate source. (emphasis added by FTB)

    A PA could be an appropriate source. You would need the PA's NPI number for your claim.

    And in response to Melindathi - if the PA is credentialed independently, the PA may be determining a plan of treatment.

    A word of CAUTION ... you write "if the patient was referred by ..." A referral is NOT the same as a request for consultation.

    Your physician may code a consultation if that was what was requested and provided. If the patient was referred, it's more likely a transfer of care.

    F Tessa Bartels, CPC, CPC-E/M

  5. #5
    North Carolina
    Agreeing with Tessa...........

    Specifically, a consultation service is distinguished from other evaluation and management (E/M) visits because it is provided by a physician or qualified nonphysician practitioner (NPP) whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source. The qualified NPP may perform consultation services within the scope of practice and licensure requirements for NPPs in the State in which he/she practices. Applicable collaboration and general supervision rules apply as well as billing rules

    Carriers pay for a consultation if one physician or qualified NPP in a group practice requests a consultation from another physician in the same group practice when the consulting physician or qualified NPP has expertise in a specific medical area beyond the requesting professional's knowledge. A consultation service shall not be reported on every patient as a routine practice between physicians and qualified NPPs within a group practice setting.


    Consultation Request
    A written request for a consultation from an appropriate source and the need for a consultation must be documented in the patient's medical record. The initial request may be a verbal interaction between the requesting physician and the consulting physician; however, the verbal conversation shall be documented in the patient's medical record, indicating a request for a consultation service was made by the requesting physician or qualified NPP.

    See 30.6.10

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