Medicare Compliance & Reimbursement - 2015 Issue 8
Reader Question: Compare Treatment and Transfer of Care
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Article Overview
This article addresses a common medical coding question about whether a consultation can still be reported when the consulting physician later takes over treatment of the referred condition. It is written for coders and billing staff who need a high-level understanding of consultation intent, documentation expectations, and payer differences without losing sight of the distinction between consultation and transfer of care.
Why This Topic Matters
Correctly identifying the nature of the visit affects whether a consultation may be reported and whether the claim aligns with payer policy. The article helps readers understand the general framework for evaluating consult documentation and the importance of checking payer-specific rules.
What You Will Learn
- How consultation visits are distinguished from transfer of care at a high level
- What broad documentation elements are associated with a consultation
- Why payer policy can affect whether consultation reporting is available
- How the article frames the consultant’s role in relation to the originating provider
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Physician practice administrators
- Clinical documentation staff
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