One more time ...
Physicians frequently use the terms "referral" and "consult" interchangeably. No matter how many time we, as coders, try to educate them on the differences, they don't get it.
But per CMS (before 2010) the thing that decides whether a visit is a consultation is the intent of the physician who sent the patient to you.
So if Dr A sends a patient to Dr B seeking Dr B's advice/opinion on management of patient's problem, then it is a consultation. Dr B MAY determine as a result of his evaluation of the patient (which is a consultation) that treatment or diagnositic tests are warranted, and may even perform those on the same date of service. This does NOT change the fact that the E/M is a consultation.
If Dr A sends a patient to Dr B for TREATMENT of a problem (Dr A already knows what the issue is and what the recommended treatment is, but Dr A doesn't do "that" so he send patient to Dr B) then it is a transfer of care and the E/M would be a new or established patient visit.
Now, as if the waters weren't already muddy enough ... the AMA changed the definition of Consultations in the 2010 CPT book (Professional edition, pg 16): A consultation is a type of evaluation and management .... or to determine whether to accept responsibility for ongoing management of the patient's entire care or for the care of a specific condition or problem." (Emphasis added by FTB)
All that being said. If the patient is covered by Medicare you cannot bill a consult code in any case (and in some states MedicAID has decided to follow MediCARE rules). My guess is that the commercial carriers are all going to jump aboard this ship before we even figure out where the ship is headed.
Remember that AMA owns the CPT. The correct way to CODE something comes from following the CPT guidelines. CMS determines what they will pay for. Whether we can BILL a service and how we will get paid (or not) for a given procedure is determined by the carrier.
Hope that helps.
F Tessa Bartels, CPC, CEMC