Medical Billing Coding - Consultations, cpt, codes
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Thread Topic: Consultations
Topic Originator: Ruth Ann Santiago
Post Date September 22, 2008 @ 7:34 PM

Ruth Ann Santiago
September 22, 2008 @ 7:34 PM Reply  |  Email Friend   |  |Print  |  Top

I have a question regarding Pre-Op Consultations.  In an office that has the patient's PCP and a PA/NP and the patient comes in for a Pre-Op consultation-can the PA/NP perform the Pre-Op consultation and bill for it?

Any information would be appreciated, Thank You.

Ruth Ann

steve verno
October 30, 2008 @ 6:47 AM Reply  |  Email Friend   |  |Print  |  Top

That would be deemed to be an office visit and would not fit the CPT definition of a consultation.

The following are from CPT:

The services provided by the physician to any patient by their very nature are variable. The CPT codes that represent a readily identifiable surgical procedure thereby include, on a procedure-by-procedure basis, a variety of services. In defining the specific services "included" in a given CPT surgical code, the following services are always included in addition to the operation per se:

    local infiltration, metacarpal/metatarsal/digital block or topical anesthesia;

    subsequent to the decision for surgery, one related E/M encounter on the date immediately prior to or on the date of procedure (including history and physical);

    immediate postoperative care, including dictating operative notes, talking with the family and other physicians;

    writing orders;

    evaluating the patient in the postanesthesia recovery area;

    typical postoperative follow-up care.

The following is the CPT definition of a consultation:

A consultation is a type of service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source.

A physician consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit.

The written or verbal request for a consult may be made by a physician or other appropriate source and documented in the patient's medical record. The consultant's opinion and any services that were ordered or performed must also be documented in the patient's medical record and communicated by written report to the requesting physician or other appropriate source.

A "consultation" initiated by a patient and/or family, and not requested by a physician or other appropriate source (eg, physician assistant, nurse practitioner, doctor of chiropractic, physical therapist, occupational therapist, speech-language pathologist, psychologist, social worker, lawyer, or insurance company), is not reported using the consultation codes but may be reported using the office visit, home service, or domiciliary/rest home care codes.

If a consultation is mandated, eg, by a third-party payer, modifier 32 should also be reported.

Any specifically identifiable procedure (ie, identified with a specific CPT code) performed on or subsequent to the date of the initial consultation should be reported separately.

If subsequent to the completion of a consultation the consultant assumes responsibility for management of a portion or all of the patient's condition(s), the appropriate Evaluation and Management services code for the site of service should be reported. In the hospital or nursing facility setting, the consulting physician should use the appropriate inpatient consultation code for the initial encounter and then subsequent hospital or nursing facility care codes. In the office setting, the physician should use the appropriate office or other outpatient consultation codes and then the established patient office or other outpatient services codes.

F Tessa Bartels
February 12, 2009 @ 12:02 PM Reply  |  Email Friend   |  |Print  |  Top

It IS possible that you have a legitimate consultation ... depends on what the surgeon is asking for.

That being said, yes, your PA/NP may perform the consultation. Should bill under the PA/NP name NOT the physician. (can't have incident to for consults)

F Tessa Bartels, CPC, CEMC

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