Cardiology Coding Alert

Question: If a physician refers a patient to our office for treatment can this be considered a consultation? 

Codify Subscriber

Answer: Because the referral was for treatment and not asking for your physician’s opinion, the service and documentation most likely don’t meet the requirements for a consult.

According to CPT® guidelines, “A consultation is a type of evaluation and management service provided at the request of another physician or appropriate source to either recommend care for a specific condition or problem or to determine whether to accept responsibility for ongoing management of the patient’s entire care or for the care of a specific condition or problem.”

After receiving the request, your doctor would need to render an opinion based on meeting with the patient and then report that opinion about treatment back to the requesting provider.

CPT®’s E/M guidelines also state “consultation codes should not be reported by the physician or other qualified health care professional who has agreed to accept transfer of care before an initial evaluation but are appropriate to report if the decision to accept transfer of care cannot be made until after the initial consultation evaluation.”

Remember: Medicare and many other payers no longer accept consult codes. You instead report an appropriate office visit E/M code for the service.