Hello,
This has a been hot topic recently in our office and I have noticed we are having trouble with providers understanding the difference of a consult and referral.
In our system, when a requesting physician is putting an order/request for patient to see a specialist, they have the option to enter " consult only" or " referral ". Noticed when they put " consult only", the consultation provider's treatment/assessment plans mostly state to have the patient follow up with them in 2 weeks, 1 month or 4 months for results of any diagnostic test/labs that were requested.
Is it safe to say, if consulting provider is following with patient in 2 weeks or 1 month, that is not a consult CPT 99242-45?
if requesting physician doesn't have a diagnosis established and needs a specialist (consulting) to check out patient in how they can help treat, isn't that a consult?
if requesting physician does have a diagnosis already established and has tried treatment to help but is not helping, needs a specialist (consulting) to check out patient and continue to treat the established diagnosis, isn't that a referral?
Greatly appreciate any feedback in how we can help our staff and providers understand the difference.
This has a been hot topic recently in our office and I have noticed we are having trouble with providers understanding the difference of a consult and referral.
In our system, when a requesting physician is putting an order/request for patient to see a specialist, they have the option to enter " consult only" or " referral ". Noticed when they put " consult only", the consultation provider's treatment/assessment plans mostly state to have the patient follow up with them in 2 weeks, 1 month or 4 months for results of any diagnostic test/labs that were requested.
Is it safe to say, if consulting provider is following with patient in 2 weeks or 1 month, that is not a consult CPT 99242-45?
if requesting physician doesn't have a diagnosis established and needs a specialist (consulting) to check out patient in how they can help treat, isn't that a consult?
if requesting physician does have a diagnosis already established and has tried treatment to help but is not helping, needs a specialist (consulting) to check out patient and continue to treat the established diagnosis, isn't that a referral?
Greatly appreciate any feedback in how we can help our staff and providers understand the difference.
