Internal Medicine Coding Alert

Question: Can a transfer of service take place when the internist conducts a confirmatory consult? How should we code the transfer of service?

New York Subscriber

Answer: The short answer is "maybe." Technically, the confirmatory consult and the transfer of service are not related. But if a patient elects to have your physician continue to provide service after a confirmatory consult, you may report this as a transfer of service.
 
According to CPT, a confirmatory consult involves "a 'consultation' initiated by a patient and/or family, and not requested by a physician." You report this service using the confirmatory consultation codes 99271-99275. You can also code for these consults when an insurer or other physician seeks a second or third opinion.
 
Use confirmatory consult codes 99271-99275 with new or established patients when the patient wants a second opinion and when an insurer requests a specialist's opinion. The internist may provide confirmatory consults in any setting. If an insurer requests the consult to determine medical necessity prior to covering a procedure or service, report the appropriate code appended with modifier -32 (Mandated services). 
 
CPT designates that physicians should use confirmatory consults for "rendering an opinion and/or advice only." Physicians also refer to confirmatory consults as "second opinions."