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.
These fee codes 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, 03.03FZ>>
- 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, 03.07AZ)
- Repeat Consultations (03.07B, 03.07C)
- Comprehensive Consultations (03.08A, 03.08AZ, 03.08B, 03.08BZ, 03.08M, 03.08C, 03.08CV, 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