What is referral in Medical billing - Evaluate and treat

Referral.  

When the referring provider, in writing, transfers complete responsibility of treatment for a specific and/or suspected problem, the receiving provider may not code a consult.  Referrals are “evaluate and treat.”  Outpatient referrals are coded using E&M codes for office visits as the new provider assumes full control of the patient.  Inpatient referrals require the patent be transferred to the new service, at which time the new service begins coding codes from the appropriate Inpatient Hospital Services codes (unless there is a decision for surgery in which case the new attending surgeon would code 99499).  

    Example:

Consult:  Family practitioner asked the opinion of a pulmonologist regarding treatment options for a patient newly diagnosed with left-lower-lobe pneumonia and cough.

Referral:  Family practitioner requests that a pulmonologist take over the treatment of a patient newly diagnosed with left-lower-lobe pneumonia.  The chart notes indicate that the family physician will continue to manage the patient’s leukemia (initial reason for admission).