Consultation Services

Consultation Services versus Other Evaluation and Management Visits

The intent of a consultation service is that a physician or qualified NPP or other appropriate source is asking another physician or qualified NPP for advice, opinion, a recommendation, suggestion, direction or counsel. The physician asks for consultation in evaluating or treating a patient because that individual has expertise in a specific medical area beyond the requesting professional’s knowledge. Consultations may be billed based on time if the counseling/coordination of care constitutes more than 50 percent of the face-to-face encounter between the physician or qualified NPP and the patient. The preceding requirements (request, evaluation (or counseling/coordination) and written report) should also be met when the consultation is based on time for counseling/coordination.

A consultation should not be performed as a split/shared E/M visit.