Wiki Referral vs consult

[cmoon]

I work in a GI office and we get a lot of patient referrals from outside our practice. I am trying to come up with a simple description for my providers to help them distinguish between a referral and a consult. Is it fair to say that if the referring provider is asking for an opinion/diagnosis, then it is a consult. And if the referral says 'needs routine screening colonoscopy', then it would be a referral? I have one provider that is very good about documenting the 3 R's and codes alot of his visits as consults but many of them are simply their PCP saying it's time for a routine colon. I don't want to leave money on the table if they really do qualify as consults but I don't want to get paid for something we shouldn't be getting paid for.

 

[meherman@aol.com]

Check this month's Cutting Edge article about consults vs referrals. The fourth component to helping distinguish between the two is "intent".

 

[capricew]

a consult is simply another doctor asking for your physician's professional opinion/advice on a diagnosis. A report rendering your doctors opinion must be sent back to the doctor who requested the consult. No treatment is necessary. Just your doctors opinion of the treatment options for the patient regarding the already established diagnosis.

A referral is another doctor referring a patient to you for treatment outside of his own specialty.

Hopefully this helps!