Reader Question:
Consult Criteria
Published on Sun Oct 01, 2000
Question: Our cardiologist is billing for a consult and an echocardiogram on the same date. Can the cardiologist code for a consult if one is not requested?
Nebraska Subscriber
Answer: No. If the primary-care physician refers the patient to a cardiologist for a test, that is the only thing that may be billed, says Terry Fletcher, BS, CPC, CCS-P, an independent coding and reimbursement specialist in Dana Point, Calif. To bill correctly for a consult, the following three criteria, which can be found in the Medicare Carriers Manual, Section 15506, must be met:
1. The cardiologist must be asked for an opinion or advice on a specific problem by the requesting physician,
2. The request must be documented in the patients medical record; and
3. After the consultation, the consulting cardiologist must prepare a written report of findings that is provided to the requesting physician.
In this case, all that was requested was an echocardiogram. Therefore, it would be inappropriate to bill for any other service.
