April 14, 2016

Question:
What is an appropriate “source” for a consult? I asked at a recent workshop and the instructor did not have an answer.

Answer:
CPT guidelines state that a consultation must be requested by a physician or ”other appropriate source”. CPT defines other appropriate source as a physician assistant, nurse practitioner, doctor of chiropractic, physical therapist, occupational therapist, speech language therapist, psychologist, social worker, lawyer, or insurance company. Do not report a consultation requested by a patient or family member, etc., using a consultation code. Remember that Medicare no longer recognizes the consultation codes for payment. Some private payers continue to pay for consultations but this will vary by payer. The definition of “other appropriate source” may also vary by payer. Bottom line? Know your individual payer policies.

*This response is based on the best information available as of 04/14/16.