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Transfer of Care vs. Consultation

  1. #1
    Default Transfer of Care vs. Consultation
    Medical Coding Books
    When does a transfer of care occur? If a practitioner requests a consult for a particular condition and expects us to treat them for that condition isn't that a consultation? In the Medical Economics April Issue its states "that if a physician is taking over the care for the condition that the originating physician referred, then a consultation cannot be billed." In the AMA CPT Code book it clearly states "A consultation is a service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician." It goes on to say "In the hospital or nursing facility setting, the consulting physician should use the appropriate inpatient consultation code for the initial encounter and then subsequent hospital or nursing care codes. Same statement for the office setting. QUESTION: Should'nt we be able to bill an initial consultation and then any subsequent visits if not in a global period?

  2. #2
    Default
    This was always confusing to our docs. In order to bill for a consult, the referring physician is requesting an opinion or advice on how to treat the patient. Meaning, the referring physician will continue to treat the patient, but needs input. Transfer of care on the other hand, is just that, the referring physician wants the patient to see your doc for treatment.

    I hope that helps!!

  3. #3
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    North Carolina
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    Specifically, a consultation service is distinguished from other evaluation and management (E/M) visits because it is provided by a physician or qualified nonphysician practitioner (NPP) whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source. The qualified NPP may perform consultation services within the scope of practice and licensure requirements for NPPs in the State in which he/she practices. Applicable collaboration and general supervision rules apply as well as billing rules;

    The intent of a consultation service is that a physician or qualified NPP or other appropriate source is asking another physician or qualified NPP for advice, opinion, a recommendation, suggestion, direction, or counsel, etc. in evaluating or treating a patient because that individual has expertise in a specific medical area beyond the requesting professional's knowledge.

    Transfer of Care

    A transfer of care occurs when a physician or qualified NPP requests (not seeking an opinion-emphasis mine) that another physician or qualified NPP take over the responsibility for managing the patients' complete care for the condition and does not expect to continue treating or caring for the patient for that condition.
    When this transfer is arranged, the requesting physician or qualified NPP is not asking for an opinion or advice to personally treat this patient and is not expecting to continue treating the patient for the condition. The receiving physician or qualified NPP shall document this transfer of the patient's care, to his/her service, in the patient's medical record or plan of care.
    In a transfer of care the receiving physician or qualified NPP would report the appropriate new or established patient visit code according to the place of service and level of service performed and shall not report a consultation service.

    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

    30.6.10

  4. #4
    Default
    Thank you ladies.

  5. Default
    Ok- I understand all of this, but I work for General Surgeons. We have patients coming to us all the time from other physicians and we charge consults.
    Say a Family Practice physician thinks a patient has a hernia and sends them our way. The FP has asked our physicians opinion and it is documented. We confirm there is a hernia and plan the surgery. A letter is sent back to the FP telling of our findings. The FP would not then take the patient back and do the surgery. We take over care of the hernia and do the surgery.
    Is this a consult or transfer of care?

  6. #6
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    North Carolina
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    Quote Originally Posted by jenphillips View Post
    Ok- I understand all of this, but I work for General Surgeons. We have patients coming to us all the time from other physicians and we charge consults.
    Say a Family Practice physician thinks a patient has a hernia and sends them our way. The FP has asked our physicians opinion and it is documented. We confirm there is a hernia and plan the surgery. A letter is sent back to the FP telling of our findings. The FP would not then take the patient back and do the surgery. We take over care of the hernia and do the surgery.
    Is this a consult or transfer of care?
    The FP is seeking an opinion (intent) about the condition and seeking advice about treatment....Consult

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