tci General Surgery Coding Alert - 2007 Issue 9

You Be the Coder ~ Are Same-Specialty Consults Allowed?

Question: Can physicians of the same specialty request or receive a consult from other physicians of the same specialty? For instance, if general surgeon -A- requests a consult from general surgeon -B,- can general surgeon -B- bill the service as a consult?Utah SubscriberAnswer: Yes, physicians of the same specialty can request and receive consultations (99241-99245 outpatient, or 99251-99255 inpatient) from one another. A Medicare-produced Medlearn Matters article (MM4215) clarified that a physician can provide a consultation for another physician of the same specialty. The service must meet two minimum conditions, however:1. Documentation must verify all elements of...

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