ED Coding & Reimbursement Alert - 2007 Issue 12
CONSULTS: Consult Confusion Will Continue Into Next Year
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Article Overview
This article covers the unresolved confusion surrounding physician consult billing, including comments from CMS, the CPT Editorial Panel, and industry consultants about how consults are being distinguished from transfers of care. It matters to physicians, nurse practitioners, coders, and compliance staff who need to understand the current status of guidance, audit risk, and the broader regulatory environment around consult claims.
Why This Topic Matters
The piece explains why uncertainty in consult billing remains important for compliance and audit preparedness, even without immediate changes to the CPT update. It is relevant for organizations monitoring Medicare guidance, carrier behavior, and physician documentation practices.
What You Will Learn
- Why consult billing remains uncertain
- How CMS and CPT-related activity affect consult guidance
- What the article suggests about audit exposure and documentation awareness
- Which stakeholders are discussing the issue and why it matters for compliance
Who Should Read This
- Physicians
- Nurse practitioners
- Medical coders
- Billing specialists
- Compliance professionals
- Practice administrators
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