Oncology & Hematology Coding Alert

Question: Which CPT code should we report when a patient comes to our oncologist for a second opinion?

Florida Subscriber


Answer: You may think this sounds like a consult, but you shouldn't use consultation codes (99241-99255) to report this visit. Instead you should report the appropriate office (or hospital) visit code.

Example: A patient requests an appointment to get a second opinion on the treatment course her physician suggested. At the appointment, your practice's oncologist meets the requirements to report 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; medical decision-making of moderate complexity ...).

Watch for: Append modifier 32 (Mandated services) when the patient evaluation is part of a -second opinion program- required by the payer.