Pediatric Coding Alert

Question: I have a provider who documented a consultation note for a patient whom a nurse sent in for a consult. Is a nurse considered an -appropriate source- to request a consultation?

Answer: CPT® coding guidelines do not set restrictions regarding individuals who may be considered an “other appropriate source.”

Some examples of these sources may include the following: physician assistant, nurse practitioner, doctor of chiropractic, physical therapist, occupational therapist, speech-language therapist, psychologist, social worker, lawyer, or insurance company. If the provider is a registered nurse (RN) or licensed practical nurse (LPN), you should check with the payer to see if they include this level of provider, but in most cases, an RN would not be asking for advice on how to care for the patient, but rather sending the patient to the physician for care that the RN could not provide.

As you know, Medicaid does not cover consultations and some private payers have followed suit. You should check with your private payers that still accept consult codes and ask if they have specific restrictions regarding who can request consultations. Many require physician-to-physician consultations.