Note: The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.
Article Overview
This article explains the general billing concepts behind consultations, second opinions, referrals, and transfers of care. It is aimed at coders, billing staff, and clinicians who need to understand when a service is treated as a consult versus a visit and how Medicare policy changes affect consult code use. The discussion stays at a high level and frames the topic around E/M coding, payer recognition, and the role of the referring physician.
Why This Topic Matters
Correctly distinguishing consults from visits affects claim selection, compliance, and reimbursement. The article also highlights the importance of payer-specific rules, especially for organizations that still recognize consult codes.
What You Will Learn
The general difference between a consultation and a transfer of care
How payer policy can affect whether consult-related E/M services are billable
Which broad E/M code families are associated with consult-related billing changes
Why referral intent matters in distinguishing service types
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