Best answers
Our office has received information on consults and we are just wondering what is the correct thing to do. The information we have is based on Medicare guidelines and if we are understanding it correctly, it states that if our physician sees the patient at the request of their PCP but we take over care of this new problem that we should not bill a consult? We have all documentation and our docs do a letter back to the PCP in these cases.

Is this correct? Also, if so does anyone have any percentages on their ortho practices of how many are actually consults and not new or established visits?

We have been to seminars and some of this info is kinda conflicting. Just trying to get it right!



Best answers
  • Suspected problem
  • Undetermined course of treatment
  • Only opinion or advice sought. After the opinion, treatment may be initiated even if same encounter
  • Written request for opinion or advice received from attending physician, including the specific reason the consultation is requested.
  • Written opinion returned to attending physician (if a telephone call is made, both physicians must document the call in the patient record).
  • Patient advised to follow up with attending physician.
  • Final diagnosis is probably unknown.
  • Recommended request language: "Please examine patent and provide me with your opinion and recommendation on his/her condition."
  • null
Referral Visit (which you would bill a new pt E&M):
  • Known problem
  • Prescribed and known course of treatment.
  • Transfer of total patient care for management of specified condition.
  • Patient appointment made for the purpose of providing treatment or management or other diagnostic or therapeutic services.
  • No further communication (or limited contact) with referring physician is required.
  • Patient advised to return for additional discussion, testing, treatment or continuation of treament and management.
  • Final diagnosis is typically known at the time of referral.
  • Typical veriage: "Patient is referred to your office for treament or management of his/her condition."
Hope this helps on the 1st part of your question. :)