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Selina Posted Wed 31st of January, 2018 20:51:10 PM
Hello, When a patient presents without a referral letter, we had been billing consults only when the visit note has the phrase "referred by Dr. so and so for consultation and treatment of" a condition. Is it also acceptable to use consult if the phrase "referred by Dr. so and so for evaluation and treatment of" condition is listed as long as the other criteria for consults are met? Thank you!
SuperCoder Answered Thu 01st of February, 2018 01:58:57 AM


Yes, you can take it as consultation.

By definition, according to the CPT Manual, a consult is “a type of evaluation and management service provided at the request of another physician or appropriate source to either recommend care for a specific condition or problem or to determine whether to accept responsibility for ongoing management of the patient’s entire care or for the care of a specific condition or problem.”

Therefore, to bill a consultation there should be some sort of notation of a request for an opinion by the other provider. Depending on the payer, it doesn't necessarily have to be a letter from the other provider, but there should at least be a (truthful) note in the record that "Patient is sent by Dr. XYZ for evaluation of abc condition."



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