Coding Coach: Details Make 'Transfer Of Care' Black And White

Why This Topic Matters

Consultation coding can change reimbursement and reporting outcomes, especially when the referral request is written in a way that suggests treatment has already been determined. Understanding the difference between a consult and a transfer of care helps practices apply the appropriate framework for different payer policies.

Article Sections

1. Put consultation requests to this 2-prong test

   Introduces the issue of consultation coding when a referral resembles a transfer of care and frames the article around a two-part approach. It also discusses the role of CMS and CPT guidance in this context.

2. Examples and coding approach

   Uses referral scenarios to illustrate how consultation requests may be evaluated and how documentation language can support the chosen billing approach. The section also notes the broader distinction between consultation and office/outpatient coding.

3. Using different consultation guidelines

   Addresses the practical challenge of applying different payer policies and describes general strategies practices may use to manage Medicare and non-Medicare claims. It emphasizes workflow considerations and keeping payer guidance available.