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Ob-Gyn Coding Alert

Checklist for Consultation Versus Referral

Published on Tue Oct 01, 2002

There is always confusion regarding consultations versus referrals. Jean Ryan-Niemackl, LPN, CPC, of QuadraMed, offers the following questions as a guide to help you determine which scenario you are coding: Is this a suspected problem (consultation) versus a known problem (referral)? Is the treatment(s) unknown (consultation) versus known (referral)? Is an opinion being requested (consultation) versus transfer of all or partial care (referral)? Did the receiving physician give an opinion (consultation) versus seeing the patient for a known diagnostic or therapeutic procedure (referral)? Was written communication returned to the requesting physician (consultation) versus no further communication (referral)? Was the diagnosis unknown (consultation) versus final diagnosis is usually known at the time of the request (referral)? These are the types of questions that may help you understand the service you are coding. But remember, these are not exclusive rules, but tips to help make the determination a little easier.
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