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Pediatric Coding Alert

Reader Questions:

Decipher the Difference between a Referral and Consult

Published on Tue Sep 13, 2022

Question: What is the difference between a referral and a consultation and how does it affect data counting for medical decision making (MDM)?

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Answer: Generally, a consult is simply a physician asking a specialist to evaluation a situation and give insight on proper management. The treating physician is requesting outside expertise. A referral is when the treating physician turns the problem over to the specialist, along with the management of the condition.

As far as MDM is concerned, the decision to seek a referral or consult another physician shouldn’t be considered as part of the data section of the MDM table. The physician will have to decide, based on their expertise and the expertise of the consulting physician, what specific risks are associated with suggested treatments or procedures, which could potentially affect leveling. But the decision to seek outside advice won’t.

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