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Thread: Coding Question

  1. #1
    Join Date
    Apr 2007

    Default Coding Question

    AAPC: Back to School
    I recently took the 2008 CPC coding exam and want to receive clairification. If a patient is referred to see a specialist by their doctor and a referal is written out. Does the specialist who see's the patient need to write a consultation back to the referring physician in order to code this as a referring consultation? If no referall is generated back to the referring physi cian how should this be coded?


  2. #2
    Join Date
    Apr 2007
    Seacoast- Dover New Hampshire


    I would say that the Specialist needs to send a soap/progress note back to the PCP/
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3


    Consultations: 3 R's
    Request (by requesting/referring physician)
    Rendering Service (by physician consultant)
    Report (from physician consultant to requesting physician)

    The request, consultant's opinion and any services
    that were ordered or performed must all be documented
    in the patients medical record.

    I hope this helps,

    Thank you,
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default No report = new patient

    If no report is sent to the requesting physician then you have either a new patient visit (if the patient hasn't been seen in your practice and your specialty within the last 3 years) or an established patient visit.

    A consultation requires:
    REQUEST for consultation
    REASON for consult
    RENDER service
    REPORT back to requesting physician

    NOTE: A referral is not the same thing as a request for consultation. A referral is typically an insurance requirement for a patient to be seen by a specialist.

    F Tessa Bartels, CPC, CPC-E/M

  5. #5
    Join Date
    Apr 2007
    Greeley, Colorado


    I totally agree with FTessaBartels. The term referral should not be used when requesting a consultation. Also, follow the the consultatioin guidelines as noted by both previious posts.
    Lisa Bledsoe, CPC, CPMA

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