Consultations vs Transfer of Care

Consultations
Make sure you document the three R’s:

• Request for the consultation (Who requested it?)
• Reason for the opinion (Why was it requested?)
• Response back to the requesting MD (opinion and/or treatment for the patient)

Opinion/Treatment plan should be a written response of your findings for the requesting physician so that they may use it to further treat the patient.  This should include results of any diagnostic testing that was performed.  This does not need to be in a separate written report if it is a shared medical record.

Inpatient Consultation Codes:

• 99251-99255
• Documentation requirements: 3 of 3 key components
• These may be billed based on time when criteria is met
• Can only be reported once per patient per admission

Subsequent Consultation Codes:

• In the hospital setting: 99231-99233 (subsequent hospital care codes)

Effective 1/1/06 second opinions requested by the patient and/or family are not billable as a consult.  You must report them using the subsequent hospital/nursing facility codes based on the patients location. 

Transfer of Care 
A transfer of care occurs when a physician or qualified NPP requests that another physician or qualified NPP take over the responsibility for managing the patients’ complete care for the condition and does not expect to continue treating or caring for the patient for that condition. 

When this transfer is arranged, the requesting physician or qualified NPP is not asking for an opinion or advice to personally treat this patient and is not expecting to continue treating the patient for the condition. The receiving physician or qualified NPP shall document this transfer of the patient’s care, to his/her service, in the patient’s medical record or plan of care. 

In a transfer of care the receiving physician or qualified NPP would report the appropriate new or established patient visit code according to the place of service and level of service performed and shall not report a consultation service.