Practice Management Alert

Question: If our doctor does surgery on a patient who is an inpatient, shouldn't we be charging for a consult?

Georgia Subscriber

Answer: You should only bill for a consultation if the primary physician requested a consultation from your physician. In other words, only bill a consultation if the primary doc requested your doctor's opinion or advice for a treatment plan for a specific condition.

If your physician was called in just to perform a surgery, and there was no request for an opinion or recommendation, then you cannot bill a consult. But keep in mind that a consultant can lead to treatment once the physician completes his consultation.

When you submit a consult claim, you should also include documentation that explains the consultation circumstances. Documentation requirements for consults vary by payer, but experts say your consult documentation should at least include evidence of:

- a written or documented request for the consult

- the consultant's opinion

- any services the consultant provides or orders

- a written report to the requesting physician or provider.

Note: A separate report sent to the requesting physician is not required when the requesting physician and consultant share a common medical record (which always occurs in the inpatient setting).

If the service does qualify for a consultation code, bill an inpatient consultation using the most appropriate choice from 99251-99255 (Inpatient consultation for a new or established patient -), depending on the level of service.