General Surgery Coding Alert

Mandated services mean modifier 32

CPT 2006's deletion of follow-up inpatient (99261-99263) and confirmatory (99271-99275) consultations means that you must claim all same-stay inpatient follow-ups using subsequent care codes 99231-99233 (hospital) or 99307-99310 (nursing facility)--depending on the site of service--according to 2006 CPT guidelines, says Suzan Hvizdash, BSJ, CPC, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh.

You may, however, still claim initial inpatient consults (99251-99255) for the first consult your surgeon provides per inpatient stay, Hvizdash says.

Likewise, CPT 2006 deletes 99271-99275. For so-called -second (or third) opinions,- you should access -the appropriate E/M service code for the setting and type of service,- such as an office visit (99201-99215) or consult (99241-99255), CPT states.

Patients can't request a consult: Be aware that a consult must come from -an appropriate source,- which does not include the patient or patient's family. An E/M service requested by the patient or patient's family -and not requested by a physician, is not reported using the consultation codes but may be reported using the office visit codes, as appropriate,- as outlined by CPT 2006.

As in previous years, however, if a payer mandates the E/M service for a second or third opinion, you should append modifier 32 (Mandated services) to the appropriate E/M service code.

Get the whole story: For complete information on changes to consult coding in CPT 2006, see -CPT Consolidates Consult Coding for 2006- on page 84 in the November 2005 General Surgery Coding Alert.