AMA CPT® Assistant - 1996 Issue 9 (September)
Direct Transfer of Care Versus Consultation (September 1996)
September 1996 pages 1-2 Direct Transfer of Care Versus Consultation When does a consultation become a direct transfer of care? How do we determine and code for the differences in the respective services? The documentation in a patient's chart may not clarify whether an emergency department (ED) physician evaluated a patient and requested a direct transfer of care to another physician, or if the ED physician requested the opinion or advice of another physician. In the emergency department setting, ED physicians usually provide services and procedures of an acute nature and then refer the patient(s) to other physicians (eg...
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Article Overview
This article reviews documentation and coding considerations for differentiating a direct transfer of care from a consultation, with emphasis on emergency department and inpatient hospital scenarios. It is intended for coders, physicians, and billing staff who need to understand the general structure of consultation services, referral documentation, and related evaluation and management reporting concepts. The discussion covers physician responsibilities, communication expectations, and how the setting of care affects reporting.
Why This Topic Matters
Correctly distinguishing these service types affects evaluation and management reporting and supports accurate documentation in the patient record.
Article Sections
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September 1996 pages 1-2
Publication and page information for the article.
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Coding the Physician Services
General reporting considerations for physician services in emergency department and inpatient contexts, including how related procedures are handled.
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Transfer vs Consultation
Overview of the distinction between a transfer of care and a consultation within the consultation guidelines.
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Key Components of a Consultation
High-level elements described for a consultative visit and the types of activities involved.
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Transfer of Care
Discussion of what happens when responsibility for a patient’s condition is assumed by another physician and how that affects reporting by setting.
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Questions of Documentation
Documentation issues raised to help distinguish referral from consultation and clarify communication between physicians.
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Documenting the Referral
What the requesting physician or source should document when seeking another physician’s opinion or advice.
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The Consultant's Opinion
What the consultant should record and how the opinion and related services are communicated back to the requester.
What You Will Learn
- How the article frames the difference between referral, consultation, and transfer of care
- What documentation elements are emphasized for requesting and consulting physicians
- How setting and responsibility for care influence evaluation and management reporting
- What types of communication between physicians are discussed in the article
Who Should Read This
- Medical coders
- Physicians
- Billing staff
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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