Wiki HELP UGHH!! Please help with Consult requests

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mcarrillo

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:confused:
Hi,
I am having some issues at work with requests for consults. The issue is on the actual written request/referral/auth/script, whatever form of paper that we get from the referring Dr.

We are trying to find out the correct verbiage on the paper request what constitutes a true consult request or if the provider is just sending their pt to us to take care of and treat the problem/issue/Dx.

The big debate in our office is the wording "Evaluate and treat". For me, this isn't sufficient enough to be sure or assume that this is a true request for a consult (recommendation, opinion). My boss wants something in writing and current for 2015, but of course there is nothing in regulatory or legal writing that gives the correct verbiage on a request.

I have been calling to the referring Dr's office to get confirmation, I get mixed results because the referral or clinical staff are confused as well. I am waiting on a couple of call backs for them to get the provider to confirm if they want an recommendation/opinion for continued care on the problem, or if they are just sending the patient to our provider to just see the patient and treat them for the problem.

Please, please, please if anyone can give me something that is current that states what a written request should have on it for a "consult".

Thank you all.
 
CPT Assistant has some good resources regarding consults. I.e. A physician is requesting the opinion or advice of another physician regarding the evaluation and/or management of a specific problem. I have not dealt with paper referrals in some time but there should be an area to write in the dx/issue e.g syncope, reflux, headache, etc. Why are the patient's coming to your office and what you are treating them for? I would also check with the carrier regarding their referral guidelines.
 
Thank you Lukelitch and em2177 for the info.

If you received a referral form with the Dx/issue and the reason for visit states "evaluate and treat", would you consider this be a consult, 99241-99245, or a referral (transfer of care) 99201-99205 ?

Thanks.
 
mcarrillo said:
Thank you Lukelitch and em2177 for the info.

If you received a referral form with the Dx/issue and the reason for visit states "evaluate and treat", would you consider this be a consult, 99241-99245, or a referral (transfer of care) 99201-99205 ?

Thanks.
Click to expand...

I agree that "evaluate and treat" reads more like a transfer of care than a consult. "Treat" is the word that gets my attention. Just my 2 cents :)
 
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