tci ED Coding & Reimbursement Alert - 2007 Issue 12

Reader Question: Observe Differences in CMS, CPT Consult Criteria

Question: It is my understanding that if a requesting physician asks for an opinion about a condition and the consulting physician sends the patient back to the requesting physician for treatment, this constitutes a -consultation.- I also thought a -referral- is when a patient's care for a condition is transferred from one physician to another. The 2007 CPT book states that -A consultation is a type of service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source. A physician consultant may initiate...

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