Practice Management Alert

Question: Some of our providers use “consultation” and “referral” interchangeably, but it’s causing headaches for us in billing. These are different terms, right?

AAPC Forum Participant

Answer: According to the American Academy of Family Physicians (AAFP), consult and referral are not synonymous.

The organization defines a consultation as a “request from one physician to another for an advisory opinion.” The consulting physician would provide an opinion via a service and any recommendations regarding diagnosis and treatment, as requested by the initial physician. The initial — requesting — physician would remain the main provider for the patient.

A referral is also a request made by one physician to another physician, but the request is that the second physician take over management of a patient’s specific condition(s): “This represents a temporary or partial transfer of care to another physician for a specific time until resolved, or on an ongoing basis. It is the responsibility of the physician accepting the referral to maintain appropriate and timely communication with the referring physician and to seek approval from the referring physician for treating or referring the patient for any other condition that is not part of the original referral,” according to AAFP.