Cpt Medical Coding: Debating The Difference Between A Consult And Transfer Of Care

By Author: Celena Rose
Total Articles: 146
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Current Procedural Terminology or CPT medical coding offers updates every year along with the difference in opinion regarding the use of codes. Consultation guidelines can be confusing, especially when even the experts are not very sure. For example, when you try to code your physician's consultation services, the first question you should ask before reporting for office consultation for a new/ established patient or inpatient consultation is whether the requesting physician transferred the patient's care to your physician or is asking your physician for an opinion/recommendation.


The verbiage of the consultation guidelines point up that the surgeon can actually initiate treatment and order tests, but then you are left to ponder what would truly be classified as a transfer of care.


CMS says that a transfer of care occurs when a physician or qualified non-physician practitioner (NPP) requests that another physician or qualified NPP take over the responsibility for managing the patient's complete care for the condition and does not expect ...
... to continue treating or caring for the patient for that condition. The good thing about this statement is that you are unlikely to receive a denial.


Take another case of CPT medical coding scenario when a physician sends a patient to your physician for a consult and your doctor decides to treat the problem. The very first thing you should do is send the requesting physician a letter explaining the patient's problem, the physical findings, the diagnosis, the physician's opinion and recommendations. Also, state that considering the findings and conclusions, the two physicians have agreed that the second physician will provide care for this problem.


CPT 2009 might fix the problem by eliminating consultation codes altogether and end the transfer-of-care debate for a hassle-free CPT medical coding.


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