Fee Navigator®

    Governing Rule: 4.5

    CONSULTATION: PHYSICIANS ON ROTATION IN THE EMERGENCY DEPARTMENT/AACC/UCC

    • 4.5.1

      A physician on rotation duty in the emergency department or in an AACC or UCC may claim a comprehensive consultation when the conditions in GR 4.3 have been met.

      1. Deleted
      2. Deleted
    • AMA billing tips:

      • Consultations may only be claimed when ALL of the following criteria have been met:

        • Patient is examined by referring provider (full list G.R. 4.4.1)
        • Referring provider specifically requests (verbal or written)opinion and or advice of consultant
        • Consultant performs:
        1. full history and
        2. full physical (relative to their specialty)
        3. may order lab or diagnostics.
        4. discusses treatment and advice with the patient and in some cases the referring provider
        5. provides referring provider with written report about recommendations, treatment, opinion.

        Consultations may NOT be claimed for transfer of care or pre operative assessments.

        Consultations are billable up to and including the day of surgery.

    • 4.5.2

      A limited consultation may be claimed when dealing with one particular problem and shall include interpretation of laboratory tests, and a written report to the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner who must care for the patient in the future. A claim for a limited consultation may be made when there is a written request or other documented communication from the referring physician, audiologist, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist, nurse

      practitioner or their agent for an opinion or treatment by the emergency physician.

    • AMA billing tips:

      • Consultations may only be claimed when ALL of the following criteria have been met:

        • Patient is examined by referring provider (full list G.R. 4.4.1)
        • Referring provider specifically requests (verbal or written)opinion and or advice of consultant
        • Consultant performs:
        1. full history and
        2. full physical (relative to their specialty)
        3. may order lab or diagnostics.
        4. discusses treatment and advice with the patient and in some cases the referring provider
        5. provides referring provider with written report about recommendations, treatment, opinion.

        Consultations may NOT be claimed for transfer of care or pre operative assessments.

        Consultations are billable up to and including the day of surgery.