Otolaryngology Coding Alert

READER QUESTIONS:

Bill 2nd Opinions 2 Ways

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. Can you advise me how I should bill our allergist'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 office visit 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 NF Care codes (99307-99310) in the NF setting shall be reported.-

This applies to outpatient consultations (99241-99245) as well. If a primary-care physician needs the allergist to evaluate the patient and confirm his diagnosis and treatment plan, the allergist may report a consultation as long as all of the consult requirements are met.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Otolaryngology Coding Alert

View All

Which Codify by AAPC tool is right for you?

Call 844-334-2816 to speak with a Codify by AAPC specialist now.