Oncology & Hematology Coding Alert

Question: When should I use modifier 32?

California Subscriber

 Answer: You should append modifier 32 (Mandated services) to any service that the oncologist provides at the specific request of the patient's insurer.

You will usually append modifier 32 when the insurer requests a second opinion on a patient's condition before authorizing further testing or treatment.

Example: Oncologist A recommends an intensity-modulated radiation treatment (IMRT) for his patient. Before the patient's insurer approves the treatment, it asks oncologist B (in a different practice) to conduct a physical examination of the patient. In this case, oncologist B can document and report an office consultation (99241-99245) for his services.

Solution: Oncologist B should append modifier 32 to the appropriate consult code (such as 99243, Office consultation for a new or established patient ...).

Modifier 32 signals the insurer that it requested the consult and that the oncologist performed the service based on policy requirements.

Important: Medicare payers generally do not use modifier 32. Rather, this modifier usually describes procedures or services required by a third-party payer or a governmental or legislative agency.

And Medicare won't pay for a service requested by another insurer. The insurer requesting the second opinion should make payment under its policy's terms.