1) Transfer of care would mean that the Cardiologist is assuming primary care of the patient. I'm assuming that the hospitalists is still managing the patient renal failure and still the attending. The cardiologist would've been called in for a consultation due to the patient's known cardiac condition. There is no new vs established in the facility setting so this would be considered a consult.
2) I'm concerned that the cardiothoracic surgeon would transfer care within the same hospital stay of a major procedure. Most cardiothoracic surgeons continue the 90 day global follow up and refers the patient to the cardiologist for long term care.
It doesn't matter if the patient is established with the specialist. If it were a cardiac condition then the ED doc would order the cardiology consult. If the cardiologist admits the patient, the consult then become part of the H&P because here could only be one E&M submitted per day. The main thing would be in the documentation. If the attending orders a consult, then it's a consult. If the attending orders the transfer of care, then it's a transfer of care.
CMS.gov has great information for how to code E&M. In the manuals, 100-04, chapter 12, section 30.6 is the E&M guidance. You'll find direction on consultations there too. I hope this helps.
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