Forum - Questions & Answers

Dec 1st, 2009 - LindaLou 81 

Consult vs. Transfer of Care

the 2010 CPT book has changed it's verbage on consults and I think am more confused than I was before.
It states a consult can be "TO DETERMINE whether to accept responsibility for ongoing management of the patient's care or for the care of a specific condition or problem."
And later when talking about a TRANSFER OF CARE, says "(i.e....for the care of a specific condition or problem)".

Sooooo, are we to document that we are "determining" that we need to take over the care for that certain problem?

Seems like a very fine line here.

I appreciate any feedback.

Dec 1st, 2009 - LindaLou 81 

Re: Consult vs. Transfer of Care

I just got my CPT changes book which says a consult can be provided "to allow determination to be made....to accept care of a specific problem (i.e.transfer of care)."

Still clear as mud to me. It almost sounds like they are helping up bill TOC's as consults...as long as we document the decision to accept care for the problem.

Dec 1st, 2009 -

Are you talking about Commercial insurers?

Because although the codes are valid CMS said they will not honor them. It's all new patient/existing patient/initial hospital visit/subsequent hospital visit. We expect all other insurers to follow suit.

Dec 6th, 2009 - Codapedia Editor 1,399 

Consults: clear as mud to me, too

I was dumbfounded when I first read the CPT definition. It seems to me that the definition "to determine" whether to take on the care allows almost anything as a consult. I was also filtering it through CMS's words on transfer of care. My colleagues and friends at Karen Zupko & Associates reminded me: the CPT definition should not be interpreted through CMS's filter. So, read CPT's words and apply it to commercial patients for this year.

In that light, unless the consulting/receiving physician has agreed before the visit to accept the care of the patient in entirety, or for that condition, that part of the requirement for a consult will be met.



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association