Referral to Specialist

[Kreismann]

Hi,

I would like to know, if a physician refers a patient to a specialist, would this count toward any data points. How should I give credit?
Thank you

 

[thomas7331]

A referral to a specialist, by itself and without context, is not specifically called out as a data point. If the referral is simply because the provider does not treat that particular kind of problem and is having the patient go elsewhere, I normally won't give any additional MDM credit. However, the 1995 E&M documentation guidelines do state in the diagnoses and management options section that "The need to seek advice from others is another indicator of complexity of diagnostic or management problems...If referrals are made, consultations requested or advice sought, the record should indicate to whom or where the referral or consultation is made or from whom the advice is requested." I've taken this to mean that a referral, in the context of a provider needing assistance from another specialty to diagnose a problem, can be an indication of the 'additional workup', so in that case I'll give the extra point in that section. Similarly, in the table of risk, "undiagnosed new problem with uncertain prognosis" is listed as a marker of moderate complexity MDM, and if a referral is made because a provider is uncertain about the diagnosis and concerned enough to have a specialist's input, this can also contribute to the MDM level in the risk category.

 

[Kreismann]

Thank you Thomas. Your reply was very helpful.