Modifier Coding Alert
Remember Modifier 32 is Mandated
Question: We have a patient whose family has requested a second opinion concerning whether their mother requires a surgery. Can I use modifier 32?
Pennsylvania Subscriber
Answer: Modifier 32 (Mandated services) is only appropriate when a third-party has requested a service such as an evaluation, medical opinion, or a procedure. The third-party could be an insurance company, a court, or an employer. This modifier would not be appropriate in this situation.
Example: A patient has had mitral valve prolapse for several years and is now being told by her cardiologist that she needs a mitral valve replacement. The insurance company will cover a mitral valve repair, but they require a second surgical opinion prior to surgery.
Because the patient’s insurance required the second option, the cardiologist providing the second opinion should report his service with a modifier 32. If the specialist does not report modifier 32, the submission may result in a denial due to a “duplication of services” because the original physician may have already provided the service.
Warning: Medicare usually doesn’t accept modifier 32 claims and they won’t pay for services requested by another provider.
Modifier Coding Alert
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