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Thread: Consults vs Referrels

  1. #1
    Join Date
    Apr 2007

    Default Consults vs Referrels

    AAPC: Back to School
    i do the billing for the physicians at a hospital and there are over 100 physicians.. i unsure about billing consults vs referrel.. example : if a patient comes into the clinic with a foreign body in his eye,, the doctor checks it then send him to Ophthalmology clinic to be evaluated,, do i bill the eye clinic as a consult or office visit ??

  2. #2
    Join Date
    Apr 2007

    Default Same Question

    I have the same issue, sort of. My doctor is a perinatal md, and often gets orders for consults which also state possible total care. So, when he writes his letters for his consults, he will state "thank you for this referral" so am I to assume this is a referral and not a consult, and how do I code it?

  3. #3

    Default Consult Vs. Referral

    The definition of a consult is a request for advice or opinion from a provider. This professional service may occur in both inpatient and outpatient settings. A consulting provider may initiate diagnostic or therapeutic services.

    The definition of a referral is when the referring provider, in writing, transfers complete responsibility of treatment for a specific or suspected problem, the receiving provider may not code a consult. Outpatient referrals are coded using EM codes for office visits as the new provider assumes full control of the patient.

    Consult: A family practitioner asked a pulmonologist's opinion about treatment options for a patient newly diagnosed with a cough and pneumonia.

    Referral: A family practioner reuqests that a pulmonogist take over treatment of a patient newly diagnosed with pneumonia. The chart note indicates the family physician will continue to manage the patient's other diagnoses.

    I hope this helps.

  4. #4
    Join Date
    Apr 2007


    yes it is thank you,, i think some of my co-workers were confused on how to bill and then they made me start to second guess my self.. but thats what i thought, if a doctor takes over treatment then it wasn't a true consult...

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