One of the most troublesome coding decisions is whether a visit is a consultation or a referral. A consultation is a rendering of advice or your professional opinion, followed by a report of your findings to the referring physician. A consultation visit results in the patient returning to the primary care physician who initiated the care. Diagnostic testing can be provided and billed in a consultation.
The following chart summarizes the difference between a consult and a referral.
|
CONSULT |
REFERRAL |
|---|---|---|
Request |
"Please see patient for a consult." |
"Patient has been referred by..." |
Problem |
Suspected or known diagnosis |
Identified problem |
Treatment |
Undetermined or possibly known |
Known |
Requesting Physician |
Decides which physician will administer care |
Oversees and manages care |
Report |
Written report to requesting physician |
Written report to requesting physician is not necessary |
CPT Code |
Consult |
New or established patient |
The ACR has developed forms for physicians to utilize in their practice to guarantee proper documentation for consultations. These forms can be used in patients' records to show medical necessity. If you need further assistance or have questions please contact the ACR coder Melesia Tillman, CPC at (404) 633-3777, ext 820.
Download the forms through the links below (Note: all files are Word documents to allow you to customize them for your practice).
Request for Consultation or Transfer of Care for (Specialty) Services
