July 7, 2016

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

Answer:
The guidelines for a consultation (inpatient or outpatient) state that the service must be requested by a physician or “other appropriate source”. Guidelines are not clear regarding who may be considered an appropriate source, but some examples cited by CPT include a physician assistant or nurse practitioner outside of your otolaryngology practice.

Do not report a consultation requested by a patient or family member, etc., using a consultation code (9924x). Rather, use a new patient (9920x) or established patient (9921x) code instead.

*This response is based on the best information available as of 07/07/16.