Otolaryngology Coding Alert

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 bill our ENT'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 require-ments 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.-

You Be the Coder and Reader Questions were reviewed by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC; and Charles F. Koopmann Jr., MD, MHSA.