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A consultation-liaison (C-L) note records a psychiatric assessment of a hospital patient admitted under a non-psychiatric team, performed at that team's request. It answers the consult question, documents mental status, capacity, and risk, and returns numbered recommendations the requesting team can act on the same day. Most run 200 to 600 words.
Consulting psychiatrists, PMHNPs, and hospital psychologists on C-L services
The requesting medical or surgical team, the hospital record, payers, auditors
200 to 600 words · 15 to 25 minutes by hand (clinical team estimate)
Specialist consultation note (compare: psychiatric diagnostic evaluation, discharge summary)
After a bedside psychiatric assessment requested by another hospital team
No mandated format anywhere; hospital record rules and billing pathways shape the content
A consultation-liaison note is the written record of a psychiatric assessment performed on a patient admitted under a medical, surgical, obstetric, or neurological team, at that team's request, in a general hospital. It works double duty: a permanent entry in the shared record and a communication the requesting team can act on. The recognizable format has a scholarly lineage, not a regulatory one: Garrick and Stotland proposed the schema in the American Journal of Psychiatry in 1982, and Alexander and Bloch refined it in 2002 around the referrer's needs. The subspecialty itself was renamed from Psychosomatic Medicine to Consultation-Liaison Psychiatry after a 2017 board vote, with the Academy of Consultation-Liaison Psychiatry adopting its current name in April 2018. You will also hear the note called a psychiatric consultation note, C-L consult, liaison psychiatry review, or, historically, a psychosomatic medicine consult.
The legal reach is thinner than most clinicians assume. US hospital regulation touches the note only generically: 42 CFR 482.24 requires the record to contain "results of all consultative evaluations" and to be complete within 30 days of discharge, and The Joint Commission expressly leaves authentication timeframes to hospital policy. No US, Canadian, or Australian instrument prescribes a C-L format, requires a written consult request, or sets a turnaround clock. The nearest neighbor is the psychiatric diagnostic evaluation: a US initial C-L encounter is often billed as one (90792 with medical services), but that evaluation opens your own treatment episode, while the C-L note answers another team's question inside the shared hospital chart. The outbound letter that closes an outside referral loop is a consultation report; the C-L note never leaves the chart.
Consulting psychiatrists and psychiatric nurse practitioners write them on hospital C-L services, and hospital psychologists write the parallel health-psychology assessment when the primary diagnosis is medical. The trigger is a request from the admitting team: altered mental status, depression screening after a cardiac event, capacity questions around refusal of care, overdose follow-up, delirium versus depression, or agitation management. The initial assessment resembles a focused psychiatric diagnostic evaluation built around the consult question, with the mental status exam carrying the objective weight. When the patient leaves the hospital, findings worth keeping flow into the discharge summary. Two neighbors stay separate: psychiatric input delivered through a primary care program's registry review is documented in a collaborative care note, and the reply that leaves the hospital as a letter to an outside referrer is a consultation report, not a chart entry.
Consult request. Who asked, the question as they asked it, and the urgency. The stated reason anchors medical necessity for the visit code and defines what the note must answer. Pitfall: no recorded consult question; a note that never says why psychiatry was called cannot show it answered anything.
Medical context. Admission reason, relevant medications, labs, vitals, and the current medical course, briefly. The psychiatric assessment has to sit inside the medical picture, not beside it. Pitfall: a free-floating psychiatric note that ignores the anticholinergic burden, the sodium, or the post-operative day.
Focused history. Psychiatric history, substance use, current psychotropics, and collateral, selected for the question. Alexander and Bloch's point still stands: the conventional full psychiatric history serves the psychiatrist, not the requesting team. Pitfall: a clinic-length history no hospitalist will read; length is not thoroughness here.
Mental status examination. The objective core, with attention and orientation testing whenever delirium is in play. Pitfall: "alert and oriented" standing in for an examination; hypoactive delirium hides inside exactly that phrase.
Capacity and risk. Address decisional capacity whenever the question touches consent or refusal, and risk in every note. A UK hospital audit found capacity documented in 19.8% of liaison reviews and risk in 27.9% at baseline, which is the gap to write against. Pitfall: silence; these two lines are the most-missed and the most-litigated.
Impression and differential. Your clinical judgment against the medical differential: delirium versus depression, akathisia versus anxiety, intoxication versus psychosis. Pitfall: naming a psychiatric disorder without engaging the medical causes the team is worried about.
Numbered recommendations. The section the requesting team actually reads. Cover safety, non-pharmacologic steps, medication with dose and route and interactions, monitoring, and disposition, one number each. Pitfall: recommendations buried in a paragraph; if the intern cannot turn them into orders in one pass, the consult has not landed.
Communication and follow-up. Who on the team you spoke with and when, whether C-L will follow, and the plan if the picture changes. Pitfall: no documented closure; the conversation happened, the record cannot prove it.
HOSPITAL CONSULT / CONSULTATION-LIAISON NOTE Patient: ______________ MRN: __________ Date/time of consult: __________ Requesting team/attending: _____________________________________________ Consult question (as asked): ___________________________________________ Urgency: [ ] routine [ ] urgent MEDICAL CONTEXT Admission reason/date: _________________________________________________ Relevant meds, labs, vitals: ___________________________________________ FOCUSED HISTORY (psychiatric, substance, medication, collateral) _______________________________________________________________________ _______________________________________________________________________ MENTAL STATUS EXAMINATION (include attention/orientation if delirium is in question) _______________________________________________________________________ CAPACITY (decision-specific, if relevant): _____________________________ RISK (self-harm, harm to others, vulnerability): _______________________ IMPRESSION / DIFFERENTIAL _______________________________________________________________________ RECOMMENDATIONS (numbered, actionable) 1. Safety: ____________________________________________________________ 2. Non-pharmacologic: _________________________________________________ 3. Medication (dose, route, interactions): ____________________________ 4. Monitoring / labs: _________________________________________________ 5. Disposition / follow-up: ___________________________________________ COMMUNICATION Discussed with (team member, time): ____________________________________ C-L follow-up plan: ____________________________________________________ Total time (if time-based billing): ________ Signature/credentials/date: ____________________________________________
Free to use and share, no signup. The PDF includes a one-page cheat sheet with section-by-section pitfalls and a pre-sign checklist; the DOCX is the blank template, ready to adapt.
Scenario: a hospital medicine team requests psychiatric consultation for a 68-year-old man on post-operative day 2 after hip fracture repair, asking about depression and refusal of physical therapy. All details are fictional.
Consultation-Liaison Note. Patient: H.W., 68M · Date/time: 07/23/2026, 10:40 am · Requesting: hospital medicine (Dr. F. Agu) · Question: "depressed, refusing PT, please assess" · Urgency: routine, seen same day
Medical context: Admitted 07/21 after fall at home; hip fracture repair 07/21, post-operative day 2. Oxycodone 5 mg q6h prn (last dose 6:00 am), home sertraline 50 mg held since admission, diphenhydramine given for sleep 07/22. Na 131, mild renal impairment, hemoglobin stable, afebrile with normal white count. Nursing reports daytime drowsiness, awake overnight.
Focused history: Per chart, daughter, and patient: treated depression, stable on sertraline for 3 years, no prior psychiatric admissions, no substance use history. Daughter reports he was "sharp and cheerful" at baseline last week; decline began yesterday evening.
MSE: Drowsy but rousable, inattentive; months of the year backward failed at October. Oriented to person and place, not date. Speech slowed; thought process wanders. Mood "tired"; affect blunted. Fluctuation documented by nursing overnight. No hallucinations elicited; no delusional content. Denies suicidal ideation; no self-harm history.
Capacity and risk: Capacity for PT participation decisions currently impaired by inattention; expected to be restorable as the confusional state clears, reassess daily rather than escalate. Risk: no suicidal ideation, no agitation; fall risk elevated; 1:1 not indicated.
Impression: Hypoactive delirium, multifactorial (post-operative state, opioid effect, hyponatremia, anticholinergic exposure, disrupted sleep), superimposed on treated depression. "Refusing PT" reflects inattention and somnolence, not a mood decision. Not a depressive relapse on current evidence.
Recommendations: 1) Discontinue diphenhydramine; use non-pharmacologic sleep protocol. 2) Reduce opioid to lowest effective dose; scheduled acetaminophen. 3) Continue to hold sertraline today; SSRIs can contribute to hyponatremia. Resume 50 mg daily once sodium is trending up, and recheck sodium within 72 hours of restart. 4) Hyponatremia workup and correction per medicine team. 5) Reorientation measures, daytime mobilization, glasses and hearing aids at bedside; schedule PT late morning. 6) Delirium precautions; call C-L for agitation or no improvement in 48 hours.
Communication and follow-up: Findings and recommendations discussed with Dr. Agu by phone 11:35 am; nursing informed of sleep and reorientation plan. C-L will re-see 07/24. Total time 45 minutes. R. Calloway, MD, consulting psychiatrist, 07/23/2026.
This sample is fictional and for educational purposes. It does not describe a real patient.
Writing these after every session? BastionGPT drafts complete notes from bullets, dictation, or a transcript.
Generate a note from bulletsThe binding US rules are generic, and the billing layer does the shaping. Medicare stopped recognizing the inpatient consultation codes on January 1, 2010, and the AMA deleted 99251 in 2023, so the initial C-L encounter is billed as initial hospital care (99221 to 99223) or as a psychiatric diagnostic evaluation (90792, or 90791 without medical services), with follow-ups as subsequent hospital care; some commercial payers still accept consult codes, so the answer is payer-specific. That makes time and medical decision making the load-bearing documentation: an OIG audit found 87% of inpatient psychiatric facility claims with outlier payments failed medical necessity or documentation requirements. Teaching settings add 42 CFR 415.172 (the attending's presence for the key portion, documented), with a psychiatry-specific exception at 415.184 allowing observation by one-way mirror or video. Records must be complete within 30 days of discharge; everything faster than that is hospital policy, not law.
Outside the US, the written product itself is a payment condition. Australia's MBS consultant psychiatrist items treat the detailed report to the referrer as a fundamental component, and the Professional Services Review has recovered six-figure sums where records lacked a history, mental status examination, diagnosis, or management plan, including a $103,500 repayment noted in its July 2025 update. Ontario's OHIP consultation codes (A195, and A190 for 75 minutes or longer) are defined to include a written report to the referring physician. Retention: 5 years minimum under the US hospital conditions of participation with most states requiring more, 10 years under Ontario's college standard, and 7 years for adults or to age 25 for minors under the statutes in the ACT, NSW, and Victoria. Coordination work around the admission, calls to the outpatient prescriber, family meetings, and disposition legwork, belongs in a care coordination note; the consultative assessment is this note, and at the end of the stay its findings feed the discharge summary.
Two data points frame the risk. In the US, OIG estimated that 87% of inpatient psychiatric facility claims with outlier payments (FYs 2014 to 2015) did not meet Medicare necessity or documentation requirements, roughly $93 million overpaid. In the UK, the only national audit standard for liaison documentation found baseline rates of 19.8% for capacity and 27.9% for risk at a major teaching hospital. The BastionGPT Clinical Advisory Board sees the same errors most often in C-L note reviews:
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Bill the initial encounter as initial hospital care (99221 to 99223, leveled by time or medical decision making) or, when the encounter was a psychiatric diagnostic evaluation that included medical services, as 90792. Follow-up visits are subsequent hospital care (99231 to 99233). The consultation codes remain valid CPT and some commercial payers still accept them, so check the payer before assuming either way.
No regulation requires one. The practical reasons to have it anyway: hospitals typically require an order for workflow, payers expect the requesting-team relationship to be visible for medical necessity, and in Australia and Ontario a valid referral is what makes the consultant item payable. Document who asked and what they asked in the note itself.
Yes, within state scope of practice. PMHNPs can bill 90792 because it includes medical services. In facility settings, a physician and NP from the same group can share a visit, billed by whoever performs the substantive portion, defined in Medicare rules as more than half the total time. Incident-to billing does not apply to hospital inpatients.
Hospital psychologists assess patients whose primary diagnosis is medical under the health behavior assessment and intervention codes (the 96156 family), or perform a psychiatric diagnostic evaluation without medical services under 90791; the HBAI codes cannot be reported by the same provider on the same day as a psychiatric service. The psychiatric C-L note as such is written by the psychiatrist or PMHNP, and the psychologist's parallel note follows the same discipline: answer the question, examine objectively, recommend actionably.
There is no C-L-specific clock in any of the three countries. The enforceable US rule is that the record be complete within 30 days of discharge, and The Joint Commission leaves authentication timeframes to hospital policy. Same-day documentation is the professional convention because the requesting team is waiting on your recommendations, but that is your hospital's rule to set.
For the key portion of the service, yes, under 42 CFR 415.172, and their participation must be documented. Psychiatry has its own exception: 42 CFR 415.184 allows the required presence to be met by observation through a one-way mirror or video equipment. Whoever bills should personally document the medical decision making.
No. The psychiatric diagnostic evaluation is a billable service (90792 with medical services, 90791 without) with its own documentation shape, and a US initial C-L encounter is often coded as one when that fits better than initial hospital care. The C-L note is the chart document built around the requesting team's question; it can support either code. CPT allows 90791 or 90792 once per day, not on the same day as an E/M service by the same provider, and many payers limit it to once per episode of care.
As long as the hospital record they sit in. The US hospital conditions of participation set a 5-year minimum and most states require more, commonly 7 to 10 years for adults and longer for minors. Ontario's college standard is 10 years from the last entry. Australia's statutory minimums, 7 years for adults or to age 25 for minors, apply in the ACT, NSW, and Victoria; South Australia has no legislated period, so hospital policy governs there. Keep the record indefinitely where a complaint or claim is foreseeable.
Dictate the consult on the walk back from the bedside, or hand it bullets. BastionGPT drafts the note around the consult question with the examination, capacity, and risk lines in place, numbers the recommendations with doses so the team can order from them, and checks the elements reviewers test first: the question answered, time and decision making supported, and the handoff documented. BastionGPT is HIPAA-compliant with a signed BAA, and data is never used to train models.
Educational content, not legal or billing advice. Sample notes are fictional. Follow your organization's policies and your board, payer, and jurisdiction requirements.