School nurse ‘appropriate source' for pink-eye consultations

Why This Topic Matters

Determining whether a referral source qualifies and how the request is documented can affect code selection and reimbursement. The article also highlights that payer policy may differ from CPT guidance, making it important for billing staff to understand both.

Article Sections

1. Consultation reporting for school nurse referrals

   Introduces the scenario of a school nurse referral for a child with possible conjunctivitis and frames the coding choices discussed in the article. Covers the general CPT consultation concept and related visit categories.

2. CPT 2006 guidance on who may request a consultation

   Summarizes the CPT 2006 clarification on when consultation reporting is not used and how mandated services are addressed. Also notes the broader requirement for a request from an appropriate source.

3. Documenting the request for opinion and advice

   Discusses the importance of recording the consult request in the medical note and the difference between written and verbal requests. The section emphasizes documentation expectations tied to the visit reason.

4. When the condition has resolved before the visit

   Addresses the situation in which the patient is seen after the original problem is no longer present. Focuses on how the consultative nature of the encounter is supported by the referral context.

5. Private payer policy considerations

   Describes a private payer example showing that coverage policy may diverge from CPT guidance. Mentions alternative reporting categories discussed in that context.