tci Medicare Compliance & Reimbursement - 2008 Issue 33

Reader Question: Documentation Distinguishes Consult

Keep an eye on "consult and treat" requests. Question: What's the difference between a consult and a referral? How, for instance, would I report the service if my surgeon received a "consult and treat" request from another physician? Answer: You may want to clarify with the "consulting" physician what his intent was in sending the patient to your surgeon. To report a consult code (99241-99255), you must be sure that the medical record reflects all the components that make up a consultation: 1. There must be a request from one physician (or other appropriate source) that your surgeon see...

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