AMA CPT® Assistant - 2008 Issue 11 (November)
Evaluation and Management/Consultations (November 2008)
November 2008 page 10e Evaluation and Management/Consultations Question: In the guidelines for reporting consultations, does the term "physician" include a resident, or is a resident considered an "appropriate source?" Answer: Your question appears to focus on who may request a consultation with respect to payer policy. A resident physician (postgraduate trainee) is a physician. CPT uses the term "physician" in the Evaluation and Management codes to include allopathic physicians, osteopathic physicians, podiatrists, physician's assistants, nurse practitioners, and other qualified health care professionals who may perform such services within their scope of practice. The Consultation guidelines speak to referral...
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Article Overview
This CPT Assistant article discusses consultation-related evaluation and management guidance with emphasis on who may initiate or request services and how that intersects with payer, hospital, and state policy. It is aimed at coders, billing staff, compliance teams, and clinicians who need to understand consultation documentation and referral-source terminology in a non-detailed, policy-aware context.
Why This Topic Matters
Consultation claims can depend on how the requesting source is documented and how different policies interpret that request. Understanding the scope of CPT guidance versus payer or facility requirements helps users assess whether a consultation issue needs further policy review.
Article Sections
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Evaluation and Management/Consultations
This section presents a consultation reporting question and a policy-oriented explanation of how referral sources are treated in CPT and in external payer or facility settings.
What You Will Learn
- How consultation reporting questions are framed within evaluation and management guidance
- How CPT distinguishes its terminology from payer or facility policy
- Why external documentation and policy review may be necessary for consultation claims
- Which types of professionals may be discussed as referral sources in a broad sense
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Compliance professionals
- Physicians and other qualified health care professionals
- Practice administrators
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