Otolaryngology Coding Alert

Question: A family physician (FP) asks our otolaryngologist to give his opinion on a computerized tomography (CT) that a radiologist read. Our ENT reads the CT and gives his opinion but does not consult with the patient. Should I report 99271 appended with modifier -52 and send a copy of the dictated x-ray interpretation that our physician does?

Maine Subscriber

Answer: The radiologist will likely bill for the CT reading first. If this is the case, the payer will probably deny the "duplicate" charge.

Furthermore, you should not report 99271 (Confirmatory consultation for a new or established patient ...), which requires face-to-face time and a problem-focused history, a problem-focused examination and straightforward medical decision-making. The ENT only offers his opinion to the FP and does not perform the criteria necessary to bill a confirmatory consultation.

Appending modifier -52 (Reduced services) to 99271 to indicate a reduced service is also inappropriate. The scenario contains no direct patient service, which coding a confirmatory consultation clearly requires.
You should instead have the ENT provide his opinion as a complimentary service to the FP. The courtesy consultation should pay off. The FP who is grateful for the gesture should refer patients to your practice.