by J. Paul Spencer, CPC, COC
August 18th, 2017
- Either a written or verbal request for a consultation from an "appropriate source" (which is classified as a physician or other healthcare provider);
- Documentation of this request in the patient's medical record;
- Documentation of the consultant's opinion in the patient's medical record; AND
- Communication via a written report back to the requesting physician/appropriate source.
These are, and have been, the rules for consultation codes. In surveying the specific policies of the payers still willing to reimburse for this category of CPT codes, the reader will more than likely not find a dramatic variance from these rules as stated.
Paul is a Compliance Consultant with our parent organization, DoctorsManagement, LLC