Medicare Compliance & Reimbursement - 2008 Issue 2
Reader Question: Expect Consult Confusion to Continue
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Article Overview
This article addresses ongoing confusion in physician coding and compliance related to consultation services and transfers of care. It summarizes CMS and CPT-related discussion, the lack of a planned clarification in the 2008 update, and the practical compliance concerns that can follow when a specialist receives a patient for evaluation and treatment. The piece is relevant to coders, compliance staff, and clinicians who document referrals and consultative care.
Why This Topic Matters
Unclear distinctions between consultation and transfer-of-care situations can affect coding, documentation, and audit risk. This article helps readers understand the broader policy uncertainty and the compliance context surrounding physician referrals.
What You Will Learn
- Why the consult-versus-transfer-of-care issue remained unsettled at the time of the article
- How CMS and CPT-related discussions affected physician coding concerns
- What general compliance and documentation considerations were raised for specialist referrals and audits
- Why this topic was important for physicians, coders, and compliance personnel
Who Should Read This
- Physician coders
- Compliance officers
- Medical office staff
- Surgeons
- Physicians
- Nurse practitioners
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