Current Procedural Terminology (CPT®) contains very specific guidelines on reporting consultations. A consultation is defined as a service that is provided by a physician when another physician or other appropriate source requests the consulting physician’s opinion or advice concerning the evaluation and/or management of a specific problem.

Given that definition, how does CPT define “other appropriate source”?

The guidelines do not specify or restrict who may be considered an “other appropriate source.” Examples of appropriate sources are a school nurse; physician extender; physical, speech, or occupational therapist; insurance company; and lawyer. It is important to note that the patient and family are not considered appropriate sources.

Tip:If an insurance company mandates the consultation, modifier -32, mandated services, should be appended to the consultation code.

The requirements are known as the 3 Rs.

The consulting physician can initiate diagnostic or therapeutic services during the visit or subsequent visits....

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