Question: Patient care hinges in part on adequate and timely information exchange between treating providers. Referral and reply letters are common means by which doctors and nurse practitioners exchange information pertinent to patient care. Ensuring that letters meet the needs of letter recipients saves time for clinicians and patients, reduces unnecessary repetition of diagnostic investigations, and helps to avoid patient dissatisfaction and loss of confidence in medical practitioners. As a Nurse Practitioner (NP) you will need to know the difference between a consultation and a referral for treatment, when ordering and when carrying out consultations or referrals. Consultations A consultation is a request for opinion or advice, so that the requestor can manage the patient. A consultation is billed under one of the consultation codes listed in Physicians’ Current Procedural Terminology (CPT) (99241-99245 for outpatient of office consultations). If the NP is the consultant, the NP should document the request for a consultation, the reason for the consult, and the NP’s evaluation and recommendations. When an NP requests a consultation from another provider, the NP should request “consultation” on the referral form, rather than “referring.” Referrals: A referral is made when the referring provider wants to turn the management of the patient over to the referred-to provider, at least for the current complaint. When a NP refers a patient, the NP should state on the referral form that the NP is “referring the patient for evaluation and treatment.” The referred-to provider will bill an evaluation and management code, rather than a consultation code. Writing Assignment: Consult: Write up a consult request and include all key elements. Ms. Perez has been referred to Ms. Wilson FNP-C,APRN, MSN for consultation regarding eczema unresponsive to treatment in the past six months. Document the evaluation and recommendations for how Ms. Wilson FNP-C,APRN,MSN should deal with the consultation request and bill a consultation code. Writing Assignment: Referral: Write up a referral request and include all key elements. As an NP and Ms. Perez primary care provider, you decide to refer her to Dr. Owens a dermatologist for evaluation and treatment regarding eczema unresponsive to treatment in the past six months. 1. Document your referral to Dr. Owens 2. Document the evaluation and recommendations for how Dr. Owens should deal with the referral and bill a referral code.