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Thread: consult vs referral

  1. #11


    AAPC: Back to School
    We don't have a EMR yet, it is on it's way.

    So, if the requesting Dr's dictation says in it, that they are sending him over to the surgeon for whatever problem they are having, is that enough for a request?

    I still think it is a transfer of care of a particular problem and should not be coded as a consult. My surgeon now, marks a new or establish visit. This Dr. that came, is telling him to charge it as a consult everytime when a doctor of ours of different speciality sends him a patient with a known problem. I'm not sure what to do.

  2. #12
    Join Date
    Apr 2007
    Columbia, MO


    I agree it can be confusing but I agree with Laura. If the Doc A knows what is wrong and it is beyond his expertise then to me that is a transfer of care, but lets look at a couple of things,
    -- Dr. A knows his pt has rectal bleeding and requests a colonoscopy for his further evaluation. I say no consult he is requesting another physician perform a specific procedure.
    -- Dr. A knows his pt has rectal bleeding and requests a specialist evaluate the patient and suggest a colonoscopy as all other diagnostics have turned up negative. I call this a consult, it really is up to the specialist to determine the appropriate test and he is being asked for an opinion.
    -- Dr. A knows his patient has say rectal cancer, he requests an oncologist to see the patient and take care of this issue. No consult, clearly a transfer of care.
    -- Dr. A knows his patient has rectal cancer and request an evaluation by an oncologist for information on the appropriate type of antineoplastic treatment. I say consult, the specialist's opinion is being requested as to what type of treatment.
    This is the way I look at the different scenarios, I hope this is of some benefit.

  3. #13
    Join Date
    Apr 2007
    Boston, MA


    A lot of good stuff. My take on it is as follows. First ask yourself what Dr. A wanted to accomplish by sending the patient. I believe we are trying to figure out Dr. B's code here.
    If Dr. A said, I can't help this patient - Dr. B pls. take over -> transfer of care, no doubt.
    If Dr. A said, hmmm, let me see what my colleague, Dr. B, thinks about this - maybe s/he can give me some insights on how to help this patient -> consult, so long as the famous Rs are fulfilled. It is OK for Dr. B to initiate the treatment (surgery) as long as the initial intent was for a consult.
    Dr. B of course needs to send a report back to Dr. A, this is satisfied by sending a cc or a letter. In case of a shared medical record the reporting back is satisfied since both providers have access to the same record, thus a separate report is not required.
    Hope this helps.
    Karolina, CPC, CPMA, CEMC

  4. #14
    Join Date
    Apr 2007
    Columbia, MO


    I agree!

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