# consults - shared?



## codegirl0422 (Nov 20, 2008)

Hello,

We are having a debate, can consults (rather inpt or outpt) be shared (w/ a PA or CRNP)?

Does the doctor have to dictate the consult, or can the PA or CRNP do it and put "dictated for Dr. Example"?

Thank you for any advice


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## Belinda Frisch (Nov 25, 2008)

*Shared consults*

Not for Medicare.

The intent of a consultation service is that a physician or qualified NPP or other appropriate source is asking another physician or qualified NPP for advice, opinion, a recommendation, suggestion, direction, or counsel, etc. in evaluating or treating a patient because that individual has expertise in a specific medical area beyond the requesting professional's knowledge. Consultations may be billed based on time if the counseling/coordination of care constitutes more than 50 percent of the face-to-face encounter between the physician or qualified NPP and the patient. The preceding requirements (request, evaluation (or counseling/coordination) and written report) shall also be met when the consultation is based on time for counseling/coordination.
A consultation shall not be performed as a split/shared E/M visit.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf


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## RebeccaWoodward* (Nov 25, 2008)

I could not agree with Belinda more...

The Mid-level would, practically, have to be a "walking dictaphone"...rather pricey.

http://www.cms.hhs.gov/MLNMattersArticles/downloads/mm4215.pdf


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