Steve Verno
Global Moderator
Hero Member
Kudos: +203/-0
 Offline
Gender: 
Posts: 1573
|
 |
« Reply #1 on: January 22, 2009, 05:30:41 PM » |
|
Just so we understand better, the PA, an employee of the physician and practice wants to send the patient to the physician for a second opinion. Is that correct? I think we need a little more informaion.
a 99255 is as follows:
Inpatient consultation for a new or established patient, which requires these three key components:
A comprehensive history;
A comprehensive examination; and
Medical decision making of high complexity.
Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.
Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 110 minutes at the bedside and on the patient's hospital floor or unit.
Per CPT:
A consultation is 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.
A physician consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit.
The written or verbal request for a consult may be made by a physician or other appropriate source and documented in the patient's medical record. The consultant's opinion and any services that were ordered or performed must also be documented in the patient's medical record and communicated by written report to the requesting physician or other appropriate source.
A "consultation" initiated by a patient and/or family, and not requested by a physician or other appropriate source (eg, physician assistant, nurse practitioner, doctor of chiropractic, physical therapist, occupational therapist, speech-language pathologist, psychologist, social worker, lawyer, or insurance company), is not reported using the consultation codes but may be reported using the office visit, home service, or domiciliary/rest home care codes.
This one made me think. The following is from Noridian:
An NP, PA or CNS would not, however, request a consultation of his/her supervising physician. The return visit to a supervising physician is an established visit. Referral of care does not give rise to a consult, and would instead be billed with a new or established patient visit code.
Reference: Medicare Claims Processing Manual, Chapter 12, Section 30.6.10 - Consultations (Codes 99241 - 99275)(Rev. 1, 10-01-03) and Section 40.1-Definition of a Global Surgical Package (Rev. 1, 10-01-03)
Thanks
|
