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AMA CPT® Assistant - 2008 Issue 11 (November)
Evaluation and Management/Consultations (November 2008)
November 2008 page 10e
Evaluation and Management/Consultations
Question: In the guidelines for reporting consultations, does the
term "physician" include a resident, or is a resident considered
an "appropriate source?"
Answer: Your question appears to focus on who may request
a consultation with respect to payer policy. A resident
physician (postgraduate trainee) is a physician. CPT uses
the term "physician" in the Evaluation and Management
codes to include allopathic physicians, osteopathic physicians,
podiatrists, physician's assistants, nurse practitioners,
and other qualified health care professionals who may perform
such services within their scope of practice. The
Consultation guidelines speak to referral...
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articles:
Note: The following article synopsis was NOT provided by the AMA. It was created by Find-A-Code/innoviHealth.
Article Overview
This CPT Assistant article discusses consultation-related evaluation and management guidance with emphasis on who may initiate or request services and how that intersects with payer, hospital, and state policy. It is aimed at coders, billing staff, compliance teams, and clinicians who need to understand consultation documentation and referral-source terminology in a non-detailed, policy-aware context.
Why This Topic Matters
Consultation claims can depend on how the requesting source is documented and how different policies interpret that request. Understanding the scope of CPT guidance versus payer or facility requirements helps users assess whether a consultation issue needs further policy review.
Article Sections
Evaluation and Management/Consultations
This section presents a consultation reporting question and a policy-oriented explanation of how referral sources are treated in CPT and in external payer or facility settings.
What You Will Learn
How consultation reporting questions are framed within evaluation and management guidance
How CPT distinguishes its terminology from payer or facility policy
Why external documentation and policy review may be necessary for consultation claims
Which types of professionals may be discussed as referral sources in a broad sense
Who Should Read This
Medical coders
Billing and reimbursement staff
Compliance professionals
Physicians and other qualified health care professionals
Practice administrators
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articles:
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Welcome to the ultimate resource for mastering CPT coding – the CPT® Assistant. This indispensable tool, brought to you by the American Medical Association (AMA), is designed specifically for medical coders, auditors, and billers who strive for accuracy and efficiency in their daily work with patient charts. Whether you are validating codes, training staff, or appealing insurance denials, CPT Assistant provides the authoritative guidance you need to excel.
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