Billing: Consultation or Referral — Knowing the Difference
Failing to distinguish between these two types of E&M services could cost you thousands of dollars
By Suzan Hvizdash, CPC Some physicians and coders may use the terms “consult” and “referral” interchangeably. No big deal, right? Wrong. It’s a very big deal potentially worth thousands of dollars. If a practice codes a consult when the physician saw the patient as a transfer of care, the practice could collect more money than it should. Conversely, if a service is submitted as a new patient visit rather than a consult, they could be leaving thousands of dollars on the table.
Let’s delve into how to distinguish between these two types of evaluation and management services.
Suppose a new patient is seen upon request by your medical practice. The physician recommends further testing and possible surgery. The patient pays her copayment and leaves the office. Your physician is about to dictate and asks his coder how to bill the service.
What questions should the coder ask? What questions should the physician ask? What do the guidelines suggest? Continued...
