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Primary Care Coding Alert

You Be the Coder:

Determining Who an 'Appropriate Source' Is

Published on Sun May 21, 2006

Question: Parents brought their child to our office to discuss the possibility of ADD. Considering one of CPT's consultation criteria is -requested by another physician or other appropriate source,- what constitutes an -appropriate source-? Must this person be a medical professional, or could she be a teacher?


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Answer: Although CPT 2006 no longer includes confirmatory consult codes, the old codes established that a parent could request a consultation with a physician on behalf of his child and would therefore qualify as an -appropriate source.- Because of this, many coders believe that people who are not medical professionals--such as parents and/or teachers--can count as an appropriate source.

Therefore, you can only code the visit as a consultation (99241-99245, Office consultation for a new or established patient ...) if the physician meets all the consultation criteria.
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