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difference between refferal and consult - i am trying to find information

  1. #11
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    Quote Originally Posted by Jamesmmm View Post
    The doctor sending the patient does not bill a charge

    this is the referring physician

    the doctor receiving the patient does bill

    that is the consulting physician
    I agree with all of the above, that is not the issue.
    Walker Bachman, CPC, CPPM

  2. #12
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    Quote Originally Posted by Jamesmmm View Post
    I suppose you'd like to write this off to 'apples and oranges' but it's a point that should be made in any discussion of consults and referrals
    This is the part I have trouble with.

    If you are a specialist and a doctor sends you a patient, you have to determine whether it's a referral or a consult. That is what the OP was asking about, how to tell the difference. The specialist receiving the patient is going to bill that patient for the service, no matter which one it turns out to be. By saying that a referral doesn't result in a charge to the patient is just plain wrong.

    A discussion of the differences between a referral and a consult has nothing whatsoever to do with which one generates a charge. they BOTH generate a charge.
    Walker Bachman, CPC, CPPM

  3. #13
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    By saying that a referral doesn't result in a charge to the patient is just plain wrong.
    I did not say the above, but since you mention it, the referral itself will never result in a charge- what happens after the referral is made by the referring physican to the consulting physician depends on whether or not the patient is evaluated and/or treated by the consulting physician.

    A primary care physician might refer his/her patient to a cardiologist. But if the patient does not follow-up, then the "referral dosen't result in a charge to the patient"

    Thanks again

  4. #14
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    Hi W: and since you also brought up specialists, perhaps we should have pointed out to the poster that specialists are more likely to do consults than are primary care physicians (pediatricians, internists and gynecologists) and that the PCPs are more likely to refer patients for specialist care. (Consults have higher RVUs than regular visits, which may account for Medicare eliminating them.)

  5. #15
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    True, but it's the same for a consult. If the doctor sends the patient to a specialist for a consult, but the patient doesn't keep the appointment, then the consult doesn't result in a charge to the patient either.

    The differences we are discussing about charges to the patient are immaterial to question of whether an incoming patient to a specialist is a consult or a referral. The determining factors to differentiate between a referral and a consult are, and always have been:

    1. The intent of the doctor that is sending the patient to the specialist
    2. The documentaion in the medical record
    3. The existance (or not) of a report from the specialist back to the original doctor

    Saying that one generates a charge to the patient and one doesn't is wrong and immaterial to the discussion at hand. It does not help the specialist who is trying to decide which code to bill make his or her decision.
    Walker Bachman, CPC, CPPM

  6. #16
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    okay thanks for that

  7. #17
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    I guess we'll just agree to disagree and move on. C'est La Vie !!
    Walker Bachman, CPC, CPPM

  8. #18
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    I completely agree with Walker....

    Consultation-A consultation is a rendering of advice of a providers professional opinion, followed by a report of their findings to the requesting physician. The condition is undetermined or suspect...

    Referral-The primary care does not expect to continue to treat the patient for the current condition (colitis) and refers the patient to a GI specialist (example) for treatment. The problem has already been identified and the PCP simply needs a specialist to provide on-going treatment. This is a transfer of care....

    In either case both visits ARE billable. The specialist accepting the referral (transfer of care) certainly isn't going to provide this service for free...Nor would the consultant.
    Rebecca CPC, CPMA, CEMC




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  9. #19
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    Thank you Rebecca
    Walker Bachman, CPC, CPPM

  10. #20
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    I have to agree with you on this Walker.

    Penny Neece CPC, PCS
    Neurosurgery of Kalamazoo

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