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Physician Referral Letter and Consult Note
Paste your notes and one numbered question, and get a one-page referral letter or reply written in matching numbering.
River's referral letter and consult note starts from the one thing most referrals leave out: what is being asked. You state the question, paste your notes, and the letter gets built around it. The question sits in the first line. The pertinent history follows because it bears on that question, and what has already been tried follows because the receiving clinician will otherwise try it again. Everything not connected to the question stays out of the letter and goes in the attachments.
Every template that ranks for this search is organized around the sender. Demographics, history, medications, findings, signature. Fill in the boxes and a complete letter comes out that never says what it wants. That is the most common complaint from the receiving end, and no template fixes it, because a blank field labelled reason for referral gets filled in with a diagnosis. A diagnosis is not a question. This one refuses to write the letter until there is one.
It works both directions, which is the other half. A reply written against the same numbered question closes the loop, and a reply to a referral that asked nothing says so plainly rather than guessing in silence. The clinical content is always the clinician's, quoted from what they wrote. Where the history arrived as a stack of scans from elsewhere, an outside records chronology is what you cite it from, and a criteria map covers the authorization side.
Medicare stopped paying for consultations in 2010
The billing assumption behind most referral advice is out of date. Effective 1 January 2010, CMS says the consultation codes are no longer recognized for Medicare Part B payment, and physicians code the visit by where it happens and how complex it is. So a letter is no longer what justifies a consult code, because there is no consult code. Which frees the letter to do the only job actually left to it, which is being useful to whoever reads it.
Two rules still bite. A diagnostic test must be ordered by the treating physician who uses the results in managing that specific problem, so a letter needs to be clear about who is ordering and who will act on the result. And certified systems must send and display a transition of care or referral summary in a standard document template. The standard governs structure and transport. It says nothing about whether a question is in there.
Kettleman Cardiology read its 240 incoming referrals for one thing: whether a question was stated. Seventy-one were. The other 169 named a diagnosis, or asked for an evaluation. Of those 169, fifty-eight needed a call back to the referring office before the visit could be run properly, against six of the 71 that stated a question. The practice then put one numbered question on every referral it sent, and replies that answered it rose from 96 of 174 to 149 of 180.
How it works
Pick a direction
Sending a referral, replying to one, or chasing a reply that never came.
State the question
One question, in your own words. If there is not one, it says so.
Paste the notes
Your own documentation, the results, and the list of what has already been tried.
Read and sign
The letter comes back in one page, question first. The clinician signs it.
What you get
- The question in the first line, numbered, so a reply can answer it directly
- Only the history that bears on the question, with the rest moved to attachments
- What has already been tried, with start and stop dates, so nobody repeats it
- A stated boundary: which decision is yours and which one you are handing over
- The reply written in the same numbering as the question it answers
- A refusal to write the letter when nothing specific is actually being asked
Common questions
What if I do not have one clean question?
Then it will tell you, and that is deliberate. Two questions get numbered one and two, which is fine. No question at all gets you a stop and a prompt, because a letter that asks nothing puts the whole job on the person receiving it. Working out what you are asking takes five minutes and it is the five minutes that matters.
Does it write the clinical content?
No. Every clinical sentence is quoted or closely paraphrased from your own notes, dated and attributed. It decides what belongs on a one page letter and what moves to the attachments, which is an editing job. What is wrong with the patient and what should happen next remain entirely yours.
How do I reply to a referral that asked nothing?
Say so in the reply, in one line, and then answer the question you inferred. Naming the inference is the whole trick. It tells the referring office what you assumed, gives them a chance to correct it, and over a few months it is the only feedback they will ever get about their own referrals.
Does the letter still matter for billing?
Not the way people assume. Medicare dropped the consultation codes in 2010, so the visit gets coded by setting and complexity and the letter is not what justifies a code. It still matters for the ordering rules, because a test has to be ordered by whoever is treating the problem and using the result. Whether the note supports what was billed is a documentation review question.
Why not just send the whole chart?
Because a complete record is the same as no record when someone has eleven minutes. A conformant referral summary can carry every problem, every medication and every result, and still leave the reader unsure what is wanted. Attach the whole thing by all means. The letter is the one page that says what to look at and why.
What if the records came from somewhere else?
Then the letter cites them rather than absorbing them. A dated chronology of received records gives you the source page for every line, so the referral can point at a document instead of paraphrasing it. Building that chronology first is what the outside records summary is for.
Can we track whether replies actually answer us?
Yes, and it is the one number worth watching. Log the question you asked, the date you sent it, the date the reply came and whether it answered that question. Three of those are easy. The fourth is the only one that tells you whether your referrals are working, and almost nobody records it.
Physician Referral Letter and Consult Note
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