E/M Consultations and ‘The 4 Rs’

A physician's primary goal is to deliver comprehensive care to the patients they serve. And sometimes, to achieve that goal, it requires physicians (and other healthcare providers) to seek assistance from their colleagues. This assistance can be in the form of a simple question, or in the request of a clinical consultation.

Things get confusing when we try to bill for these services. If you spend any time at all on billing and coding forums, you’ll notice a lot of the questions pertain to billing, coding, or auditing E/M consultations. We get it, it’s confusing. After all, how are you supposed to know what qualifies as an E/M consultation?

Our experts here at Healthicity use a simple formula called "The 4 Rs," which are kinda like the 4 horsemen of E/M consultation billing:

• Request: Requests must come from another provider for a consultation.
• Reason (or Intent): This must be clear that the requesting provider is asking help in the evaluation or treatment of the patient.
• Rendering of Service: The consulting provider must perform a face-to-face visit with the patient in order to qualify.
• Report: A written report from the consulting physician's findings and recommendations must be provided to the requesting physician.

Keeping the 4 Rs in mind, can you tell which dates of service qualify as a consultation? Are you sure? Take this short quiz and find out.