New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 57 - PODIATRY SERVICES
Subchapter 2 - PROVISION OF SERVICES
Section 10:57-2.5 - Consultation policies
Current through Register Vol. 56, No. 18, September 16, 2024
(a) A consultation is recognized for reimbursement only when performed by a specialist, as the term is defined at 10:57-1.3, who is recognized as such by this Program and the request has been made by or through the patient's attending physician or other licensed practitioner and the need for such a request would be consistent with good medical practice. Two types of consultation are recognized for reimbursement--comprehensive consultation and limited consultation.
(b) If a consultation is performed in an inpatient or outpatient setting and the patient is then transferred to the consultant's service during that course of illness, then the provider shall not bill for an initial visit if he or she bills for the consultation.
(c) If there is no referring physician, podiatrist or licensed practitioner, then an initial visit code should be billed instead of a consultation code.
(d) If the patient is seen for the same illness on repeated visits by the same consultant, these visits are considered routine visits or follow-up care visits and not consultations.
(e) Consultation codes will be declined in an office or residential health care facility setting if the consultation has been requested by or between members of the same group, shared health care facility or physicians, podiatrists and/or licensed practitioners sharing common records. A routine visit code is applicable under these circumstances.
(f) If a prior claim for comprehensive consultation visit has been made within the preceding 12 months, then a repeat claim for this code will be denied if made by the same physician/podiatrist, physician/podiatrist group, shared health care facility or physicians/podiatrists using a common record except in those instances where the consultation required the utilization of one hour or more of the podiatrist's personal time. Otherwise, limited consultation codes would be considered the applicable codes to utilize if their criteria are met.
