What is consultation in the medical billing context?

In medical billing, a consultation refers specifically to a situation where a provider seeks medical advice from a specialist regarding a patient's condition. This typically occurs when the primary care physician or another healthcare provider recognizes that a patient's condition requires expertise beyond their own and therefore refers the patient to a specialist for guidance on diagnosis or treatment options.

During this process, the specialist evaluates the patient and offers their medical opinion, which can also include recommendations for further management or treatments. This interaction not only helps in providing comprehensive care for the patient but also serves as a basis for billing the consultation service performed by the specialist.

This distinction is particularly important because the appropriate billing codes and reimbursement can be influenced by the nature of the consultation, which involves the request for professional expertise rather than simply following up on a patient's routine care or discussing plans with another provider.