Gastroenterology Coding Alert

Question: Our gastroenterologist spends a lot of time on confirmatory consultations that insurers request, which I report with modifier -32. No matter which insurance I report to, however, they only pay the allowed amount. I'm puzzled at the purpose of the modifier -- why is modifier -32 even on the CPT books? Arkansas Subscriber Answer: Modifier -32 (Mandated services) helps insurance carriers separate claims. However, even though it may not fatten your office's bottom line, you should definitely append modifier -32 when an insurer requests a consultation. Simply put, insurance companies are usually going to pay only their allowable amount. You can charge as much as you want to on the bill, but you can't actually make the insurance company pay more than the allowable amount. Why bother? So why use modifier -32 at all? This modifier is informational and tells the payer that the consult was initiated at the insurer's request and is not a redundant claim that simply repeats what the initial consulting physician performed.