If It's a Procedure, It's Not A Consult

Why This Topic Matters

Accurate consult documentation can affect whether a claim is supported as a higher-level evaluation service or reduced to a lower-paying follow-up visit. The article highlights why referral purpose and documentation content are important for audit risk and reimbursement.

Article Sections

1. Consults versus procedures

   Explains the general distinction between referral for evaluation and referral for a procedure, and why that distinction affects how an encounter is viewed in the record.

2. Documentation expectations for a consult

   Describes the kinds of documentation elements expected when a surgeon evaluates a referred patient, including communication back to the referring physician.

3. Billing impact and follow-up considerations

   Addresses how documentation quality can influence the level of service supported and discusses the effect on payment when a consult is not clearly documented.