Medicare Compliance & Reimbursement - 2018 Issue 4
Documentation: Recognize Referral, Consultation Differences, Add to Your Bottom Line
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Article Overview
This article explains the documentation distinctions between referrals and consultations and discusses how those differences affect E/M reporting. It is written for coders and billing staff who need to understand payer preferences, documentation requirements, and the general categories of office and inpatient consultation guidance covered in CPT.
Why This Topic Matters
Correctly distinguishing referrals from consultations can affect claim selection, compliance, and reimbursement. The article is relevant for practices that document and bill evaluation and management services across office and hospital settings.
What You Will Learn
- How referral and consultation scenarios are differentiated in documentation
- What general documentation elements are associated with consultation reporting
- How payer policy can affect whether consultation codes are used
- What broad E/M service categories are discussed for office and inpatient settings
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Compliance staff
- Physicians and non-physician practitioners
Codes Discussed
Code Ranges Discussed
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