Orthopedic Coding Alert
Use E/M Code for Patient-Generated Second Opinion
Question: I know that CPT deleted the confirmatory consult codes for billing second opinions, but I-m not sure how we should report these services now. Would you advise me how I should report our orthopedist's work performing a second opinion?
Illinois Subscriber
Answer: If a patient presents to your practice and requests a second opinion, you should report the appropriate E/M code (99201-99205 for new patients, 99212-99215 for established patients). Because most second-opinion requests are patient-generated, you should treat these office visits as you would any other E/M visit.
Caveat: In some rare cases, you may encounter a physician-generated second-opinion request that can qualify as a true consultation. According to CMS Transmittal 788, dated Dec. 20, 2005, -In a facility setting, a second-opinion consultation arranged through the attending physician shall be reported by a physician/qualified NPP using an appropriate initial inpatient consultation code [99251-99255] when the consultation requirements are met. When consultation requirements are not met, the Subsequent Hospital Care codes (99231-99233) in the hospital setting and the Subsequent Nursing Facility Care codes (99307-99310) in the NF setting shall be reported.-
Therefore, if you can prove that a physician-generated second opinion is an actual consultation, you can bill the consult codes -- but only if the orthopedic surgeon's documentation supports it.
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