Consult vs transfer of care


Corpus Christi
Best answers
Please explain the difference

in order to meet pqrs we had decided our office(specialists) notes would state "patient is seen is transition of care from referring physician(pcp)"

can we bill a consult code for these visits? (nonmedicare)


True Blue
Best answers
Consult Requires a request for Opinion, Rendering and opinion and sending a written report of the opinion back to the physician (sometimes treatment is initiated by the specialist. The point of a consult is to give feedback to the ordering physician on how to treat the patient.


Best answers
Here is how I handle the situation you describe. My threshold is what the provider knows on the outside of the door before he enters a patient's room, assuming s/he has already reviewed the case. (1) If it is known that he will take over management of the patient's condition before he sees the patient I instruct them to bill transfer of care. (2) If it is not known, before s/he enters the room or by the end of the encounter, then they can bill a consult if all consult requirements are met (3 Rs). (3) If it is not known before the provider begins the encounter and decided after consultation I instruct them to document it to make clear a consult was necessary before decision could be made, also document the three Rs and bill a consult.

Our external auditor disagrees with me. She insists it is a transfer of care even if the decision can not be made until after the encounter has concluded. So, there are varying opinions. I will attend a WPS conference next month and this is at the top of my list for Q&A clarification.

Seems to me, I developed my opinion based on something I read from either AAPC, WPS, AHIMA or Medicare. I was googling, trying to find my way back to that source when I stumbled upon this thread. :)
Last edited: