Anesthesia Coding Alert

Question: I know that CPT deleted the confirmatory consult codes for billing second opinions, but I'm not sure how we should report these services now. How should I bill our anesthesiologist's work when he performs a second opinion?

Illinois Subscriber


Answer: You are correct " CPT 2006 deleted codes 99271-99275 and said, "For confirmatory consultation, see the appropriate E/M service code for the setting and type of service (e.g., consultation)."

That means if a patient presents to your practice and requests a second opinion, you should report the appropriate E/M code (99201-99205 for new patients, and 99212-99215 for established patients) for the service. Because patients generate most second-opinion requests, you should treat these office visits as you would any other outpatient E/M service.

Caveat: In some rare cases, you may encounter a physician-generated second-opinion request that can qualify as a true consultation. Remember to append modifier 32 (Mandated services) to the office visit code when the carrier requires a second opinion.

According to CMS Transmittal 788, dated Dec. 20, 2005, "In a facility setting, a second-opinion consultation arranged through the attending physician shall be reported by a physician/qualified NPP using an appropriate initial inpatient consultation code [99251-99255] when the consultation requirements are met. When consultation requirements are not met, the subsequent hospital care codes (99231-99233) in the hospital setting and the subsequent NF care codes (99307-99310) in the NF setting shall be reported."