Gastroenterology 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 gastroenterologist's work performing a second opinion?

Illinois Subscriber

Answer: 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). Because patients generate most second-opinion requests, you should treat these office visits as you would any other E/M visit.

Caveat: In some rare cases, you may encounter a physician-generated second-opinion request that can qualify as a true consultation.

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.-

Note: If the patient's insurance company requires the second opinion, you should report the appropriate E/M code with modifier 32 (Mandated services).