1. It's not exactly a 'thank you' letter - to bill a "consult" code, you have to have a request for a doctor's opinion, from a qualified source (eg, doctor, PA, etc.), then the consulting doctor sees the patient, and makes recommendations (either on the patient's diagnosis or treatment plan), which he sends back to the requesting provider, in writing. He's not saying "thanks", as much as "here's what I think".
2. A referral is different - it's when a patient is sent to another provider, with the intent of having that provider assume responsibility, for managing a particular condition. You don't bill consult codes for referrals - just regular E/M's, depending on the place of service, as usual.
3. Unless the providers are from different specialties within your clinic (eg, Family practice & IM, or GI, etc.), it's not really a referral - you 'refer' patients to someone with expertise in a specific area, which is why the vast majority of referrals, are to specialists.
4. Assuming the doctors are from different specialties, you still want to be careful about making referrals to someone else inside of your practice, to avoid violating the STARK or Anti-Kickback Statutes (see this page: http://oig.hhs.gov/compliance/safe-h...ions/index.asp and look at the info on the Safe Harbors and Physician Self-referral law, in particular - I recommend reading every publication that the OIG has to offer; they're very informative, and will give you invaluable info on compliance)
And finally, if you share charts, for either for a consult or referral, the request can be documented once in the record. Also, the written response required for consults can be documented in a shared chart, but the requesting physician should confirm that they read it, in their own entries. There's no need to mail a separate copy...hope that helps!
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