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Thread: Consultation Question

  1. #1

    Unhappy Consultation Question

    AAPC: Back to School
    I am looking to find more specifiic examples of the 3 R's when billing for a consultation. I need better guidelines please.

    Does the "request" have to be in writing from the referring doctor? How does a phone call between doctors need to be documented?

    Does the "response" have to be a seperate letter or is sending a copy of the note sufficient?

    Thanks you so much for your help!!!

  2. #2
    Join Date
    Apr 2007


    See below from the Medicare Carrier's Manual, Chapter 12, Section 30.6.10. at http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf. It gives you all the requirements and guidelines for consultations.

    The three "R's" (request, reason, report) are underlined below from the referenced section.
    A request for a consultation from an appropriate source and the need for consultation (i.e., the reason for a consultation service) shall be documented by the consultant in the patient’s medical record and included in the requesting physician or qualified NPP’s plan of care in the patient’s medical record; and
    After the consultation is provided, the consultant shall prepare a written report of his/her findings and recommendations, which shall be provided to the referring physician

  3. #3
    Join Date
    Apr 2007


    A good rule to determine a consultation vs referral:

    Suspected problem, undetermined course of treatment, only opinion or advice sought. After the opinion, treament may be initiated even if same encounter. Written request for opinion or advise received from attending physician, including the specificc reason the consultation is requested. Written opinion returned to attending physician (if a telephone call is made, both physicians must document the call in the patient record). Patient advised to follow up with attending physician. Final diagnosis is probably unknown. Recommended request language: "Please examine patient and provide me with your opinion and recommendation on his/her condition."

    Known problem. Prescribed and known course of treatment. Transfer of total patient care for management of specified condition. Patient appointment made for the purpose of providing treatment or management or other diagnostic or therapeutic services. No further communication (or limited contact) with referring physician is required. Patient advised to return for additional discussion, testing, treatment or continuation of treatment and management. Final diagnosis is typically known at the time of referral. Typical verbiage: "Patient is referred to your office for treatment or management of his/her condition."

    Kiana CPC, CPC-H, BCS-M, BCS-R

  4. #4


    The request can be in writting or verbal. if the request is verbal document the request the patients chart.

    The report back can be a letter or the actual office note.

  5. #5
    Join Date
    Apr 2007
    North Carolina

  6. #6
    Join Date
    Apr 2007

    Thumbs up

    A shout out to Kiana - this was information that I'd not seen before explanation-wise. Love it - thanks!

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