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Consultations

  1. If you have a provider in a family practice clinic who is dual credentialed, in family practice and sports medicine and this provider is also a “supervising” provider for the PA, is it okay for the PA to request a consult for the sports medicine practice?

    Answer:
    Although sports medicine is a CMS-recognized area of provider specialty, the physician in the situation you describe is acting in a supervisory capacity for a PA, who has requested his/her opinion. This does not qualify as a consultation, or a separately payable visit. The supervising physician should see the patient at the PA’s request, and one E/M service should be billed for that DOS, representative of both the PA’s and physician’s combined efforts. Updated 6/9/2017
     
  2. Please clarify statement indicating “consultative services may be performed on a split/shared visit between physicians and NPPs.” This conflicts with MLN Matters article SE1010 stating the split/shared rule.

    “How should E/M services previously reported by CPT consultation codes and provided in a split/shared manner be billed?

    The split/shared rules applying to E/M services remain in effect, including those cases where services would previously have been reported by CPT consultation codes.”

    Answer:
    CMS rules on consultative services have not changed, despite the use of standard E/M coding for inpatient and outpatient consultative services since 2010. Consultation services may not be split/shared and must be performed solely by the billing provider. Updated 4/17/2019

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