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Physicians often see patients at the request of another physician. That’s simple enough. What can get complicated is determining when that is considered a consultation and how to bill for it.
The first step is to consider what constitutes a consultation, advises Brett Baker, a reimbursement expert with the American College of Physicians-American Society of Internal Medicine.
For instance, a consultation usually occurs when a physician requests the opinion or advice of another physician on the evaluation or management of a specific problem, he notes. The person requesting the opinion or advice does not necessarily have to be a physician.
During a consultative visit, a physician:
• offers an opinion or advice to the requesting physician;
• makes a decision for treatment option(s);
• performs and/or orders distinctive diagnostic and/or therapeutic procedures.
To be able to bill for a consultation, Baker says you must:
• document your advice or opinion;
• document any services you performed or ordered;
• communicate this information to the requesting physician.
"This communication can be a letter sent back to the requesting physician. It can also be a conversation if both you and the requesting physician document what you discuss," he says.
Important: The physician who requested the opinion or advice must document in the patient’s chart the reason for requesting the consultation.
"If your encounter with a patient at the request of another physician meets these criteria, then you are free to bill for a consultation," says Baker.
Tip: As part of your documentation, identify the physician who asks for your opinion or advice as the "requesting" physician." "Don’t allude to the requesting physician as the referring’ physician," warns Baker, "since that term indicates a physician who has transferred a patient to another physician’s care."