Evaluation and Management, Consultation (Q&A) (August 1997)
August 1997 page 19c
Coding Consultation
Evaluation and Management, Consultation (Q&A)
Question
In the consultation guidelines, a consultation is defined as 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. Please define "other appropriate source".
AMA Comment
From a CPT coding perspective, CPT guidelines do not set restrictions regarding individuals who may be considered an "other appropriate source." Some common examples may include a Physician Assistant, Nurse Practitioner, Doctor of Chiropractic, physical therapist, occupational therapist, speech-language therapist...
Note: The following article synopsis was NOT provided by the AMA. It was created by Find-A-Code/innoviHealth.
Article Overview
This article explains a consultation-related CPT question and the CPT Assistant comment addressing who may qualify as an "other appropriate source" for consultation requests. It is relevant to coders, compliance staff, and clinicians who work with evaluation and management documentation, especially when payer policies may differ from general CPT guidance. The article focuses on high-level consultation guidance and how third-party payer policies may affect interpretation.
Why This Topic Matters
Consultation coding can depend on who requests the service, and payer-specific rules may differ from general CPT guidance. Understanding the scope of acceptable request sources helps reduce reporting errors and policy mismatches.
What You Will Learn
How the article frames a consultation question within CPT evaluation and management guidance.
What kinds of requester roles are discussed as examples of an "other appropriate source."
Why third-party payer policies may need to be checked in addition to CPT guidance.
How the article positions consultation guidance in relation to payer-specific restrictions.
Who Should Read This
Medical coders
Coding auditors
Compliance staff
Physicians and other clinicians
Practice managers
Billing staff
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