Consultations

Criteria:

All of the following criteria must be met:

• The referring practitioner (i.e., physician, midwife, chiropractor, podiatrist, dentist, optometrist, physical therapist or nurse practitioner) must have examined the patient first and requested a consultation.
• The referring practitioner makes a request (either verbal or written) for an opinion from the consulting physician.
• The consulting physician completes a history, examination and review or ordering of diagnostic material. The physician then provides a written opinion with recommendations about treatment to the referring practitioner.  Consultations may include a discussion with the patient and or the referring practitioner.

This fee code may not be claimed for the following:

• Transfer of care, 03.03AO, 03.03AU, 03.03AI, TOC >> 
• Follow-up Visits in Emergency, UCC or AACC >>
• Follow-up Visits Post-consultation, Repeat visits, 03.03F, 03.03FA >>
• Repeat consultations initiated by the consultant. These should be claimed as office visits (03.03A, 03.03F).
• Pre-operative History and Physical Examination, 03.04M >>
• In addition to a callback at the same encounter:
  • Callback to Closed Office, 03.05S >>
  • Callbacks to Long-term Care >> 
  • Special Callbacks to Hospital Inpatients >> 
  • Special Callback to Hospital Outpatients >>

Related fee codes

• Minor Consultation (03.07A)
• Repeat Consultations (03.07B, 03.07C)
• Comprehensive Consultations (03.08A, 03.08B, 03.08M, 03.08C, 03.08F, 03.08H, 03.08K, 03.09A, 03.09B)

Governing rules

4.3, 4.4, 4.5, 4.6, 6.6.4, 6.8.1