General Surgery Coding Alert

Reader Question ~ Consult Request Doesn't Have to Name Names

Question: How specific must a consult request be? I know there must be a specific reason for the request, but does the request have to specify by name the physician who should provide the consult?


Georgia Subscriber


Answer: Although a requesting physician certainly may request a consult from a particular specialist, it isn't required. Neither AMA nor CMS guidelines state that the consultation request specifically name the physician who provides the consult.

Theoretically, as long as the request specifies the problem, any physician with the expertise to provide his opinion may provide the consultation service. The requesting physician might only send a patient to a particular practice, for instance, rather than to an individual physician, for consultation.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

General Surgery Coding Alert

View All