Wiki Referral/Consultation

[khdalton]

Patient is referred to physician for a breast reconstruction. Referring physician will perform the mastectomy. When billing an E/M office code for physician performing breast reconstruction would I bill as a referral or a consultation.
kd

 

[FTessaBartels]

Referral

Well you started out by saying the patient was sent for a referral for reconstruction, so I think you answered your own question.

But I can envision a scenario when a patient is sent to the plastic surgeon for a consultation to get information on options following mastectomy.

It all depends on the intent of the physician who sent the patient to you, and on the documentation of your physician as to what service was performed.

Of course, if the patient is covered by Medicare you cannot use the consultation codes in any case.

Hope that helps.

F Tessa Bartels, CPC, CEMC