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I just read the following statement in the June 2011 General Coding Surgery Alert issue regarding transfer of care vs. consultation. I finally think I get it straight and then I read a different interpretation. I work for general surgeons and most often the diagnoses is known when the patient gets to our office. Tests have been already been done by the primary or other specialist to determine the diagnoses, so we know if the patient has gallstones, breast cancer, colon cancer, etc. We had been coding these as a consultation if we had a referral that specifically requested a consultation (assuming that they still wanted the doctors opinion) or use the word evaluation, otherwise we have felt that these were a transfer of care because the doctor referring the patient to us was not asking for our opinion, nor did they plan to treat the patient any further for the condition. Often doctors in our area just give the patient our phone number and fax over the test results, so we don't know the intent of the referring physician. The doctor is referring the patient to us for treatment of the known diagnoses and the patient is not going to return to the referring doctor for treatment for this particular condition. In the question and answer section below, it was worded that it can be justified by stating that the patient may be treated for RUQ pain. This seems rather misleading because you already know the none DX is what is causing the RUQ pain. You are stating the symptoms instead of the known diagnoses which was determined before the surgeon saw the patient. Help! I don't know where to draw the line for this anymore. Of course, we don't have to worry about this anymore with Medicare or the senior plans since they have stopped consultations due to the confusion, but I still feel that all of the conflicting articles that I read still spin this issue in different directions, and I certainly want to bill the other carriers correctly.
Please review the following:
Article from June 2011 General Surgery Coding Alert/Volume 13/Number 7/Page 46
Questions and Answer Section:
Distinguish Consultation, Transfer of Care
Question:
We commonly see patients referred by another physician for
conditions such as infected gallbladder, or breast or colon
cancer. Our surgeon performs an office exam that frequently
results in a later surgery. Should we code these as consultations
or transfer of care? Do we need a written notice from the
referring physician for consultations?
Texas Subscriber
Answer:
Typically, the situations you describe involve a consultation,
such as 99241 (Office consultation …), not a transfer of care.
You do not need to have anything in writing from the requesting
physician to bill a consult. That said, you should abide by some
protocols to ensure you’re billing these cases correctly.
Document consult: Although you don’t need a written
request, you do need to document a consultation service.
The documentation can come from the referring physician or
the consultant. On your end, you can justify the referral by
specifically stating in your note who referred the patient, and
for what condition. For instance, the note might say “Dr. Smith
referred Mrs. Jones for evaluation and possible treatment of
right upper quadrant pain.”
Transfer of care is different: When one physician is already
treating the patient for a specific condition and transfers that
care to a different physician, the situation is a transfer of care
rather than a consultation. You won’t often have this situation
in a surgical practice. Typically, ongoing patient care reverts to
the referring physician following surgery.
Any opinions?
Thanks,
Dee
Please review the following:
Article from June 2011 General Surgery Coding Alert/Volume 13/Number 7/Page 46
Questions and Answer Section:
Distinguish Consultation, Transfer of Care
Question:
We commonly see patients referred by another physician for
conditions such as infected gallbladder, or breast or colon
cancer. Our surgeon performs an office exam that frequently
results in a later surgery. Should we code these as consultations
or transfer of care? Do we need a written notice from the
referring physician for consultations?
Texas Subscriber
Answer:
Typically, the situations you describe involve a consultation,
such as 99241 (Office consultation …), not a transfer of care.
You do not need to have anything in writing from the requesting
physician to bill a consult. That said, you should abide by some
protocols to ensure you’re billing these cases correctly.
Document consult: Although you don’t need a written
request, you do need to document a consultation service.
The documentation can come from the referring physician or
the consultant. On your end, you can justify the referral by
specifically stating in your note who referred the patient, and
for what condition. For instance, the note might say “Dr. Smith
referred Mrs. Jones for evaluation and possible treatment of
right upper quadrant pain.”
Transfer of care is different: When one physician is already
treating the patient for a specific condition and transfers that
care to a different physician, the situation is a transfer of care
rather than a consultation. You won’t often have this situation
in a surgical practice. Typically, ongoing patient care reverts to
the referring physician following surgery.
Any opinions?
Thanks,
Dee
Last edited: