Orthopedic Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: Can we charge for a consultation if a patient has been seen in our office within the last three years but was sent for a new problem by a requesting physician? What if the patient is seen by a different doctor in our practice?

Anonymous N.C. Subscriber


Answer: Consultations are payable for new or established patients as long as all of the other requirementsa request for the service, documentation of need and a written report back to the requesting physicianare met. Consultations among physicians within the same practice are payable as long as there is a specific difference in their expertise. The difference justifies the need for the opinion from the second physician.

Note: The March 1999 Orthopedic Coding Alert included a one-page insert, Medicare Carriers Manual, Section 15506, Items A-G, Consultation Criteria, which is a handy reference to consultation questions.