Oncology & Hematology Coding Alert

Question: After a patients oncologist diagnosed him with stomach cancer (151.0, Malignant neoplasm of stomach; cardia), he came to our office for a second opinion. Should we code that visit as a new patient visit (99201-99205) or confirmatory consultation (99271-99275)?

South Carolina Subscriber  

Answer: If a patient independently seeks a second opinion without the attending physicians referral, new office visits could apply if your oncologist takes over the patients management or treatment. For example, a patient likes your oncologists care better and requests him or her to assume treatment. Your oncologist, the consulting physician, should state in his or her report that the patient sought an independent second opinion.
 
You could also use 99201-99205 if the patient independently seeks the second opinion and your physician provides more than advice or opinion, such as administering a new battery of tests to determine his or her diagnosis.
 
A confirmatory consultations purpose is to obtain a specialists guidance and recommendations regarding a previous diagnosis, evaluation and/or an attending physicians treatment plan. For instance, an insurer sends a client diagnosed with breast cancer (174.2, Malignant neoplasm of female breast; upper-inner quadrant) to your oncologist for a second opinion as a part of its internal policy, and your oncologist performs an incisional biopsy (19101) of the upper-inner quadrant a comprehensive exam of moderate complexity. So you would attach modifier -32 (Mandated services) to 99274.
 
If the patients attending oncologist requests a consult, the procedures are similar to an office consultation. A written or verbal request must be made to the consulting physician, who must provide a written report to the attending physician.