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What documentation is required for a consultation request

Rhonda Posted Thu 30th of January, 2014 13:03:32 PM

If a referring physicians office "refers" a patient to our office for treatment can this be considered a consultation?

SuperCoder Answered Thu 30th of January, 2014 19:42:20 PM

Because the referral was for treatment and not asking for an opinion, this is probably not a consult.
According to CPT guidelines, “A consultation 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.”

Then your doctor would need to render an opinion based on patient E/M, and report that opinion about treatment back to the requesting provider to complete a consult service.

CPT’s E/M guidelines also state “consultation codes should not be reported by the physician or other qualified health care professional who has agreed to accept transfer of care before an initial evaluation but are appropriate to report if the decision to accept transfer of care cannot be made until after the initial consultation evaluation …”

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