Eli's Rehab Report

Question: A chiropractor just asked our physiatrist for his opinion on whether a patient has arthritis. Can our physiatrist bill for a consult if the referring doctor is a chiropractor, not an MD?

Anonymous Idaho Subscriber

Answer: The answer is yes; the physician can report the chiropractor as the referring source, because a chiropractor would fall into the other appropriate source category.

HCFA sought to clarify the use of consultation codes in an August 1999 memo, which firmly stated three parameters necessary for using the CPT 99241 -99275 codes:

the consultation must be requested by another physician or other appropriate source;

the request and the need for it must be documented in the patients medical record;

the consultant must furnish a written report of his or her findings to the requesting physician.

In the CPT 2000 manual, the American Medical Association defines a consultation as a type of service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source.