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Pulmonology Coding Alert

Reader Question:

Second Opinion Requested

Published on Fri Feb 01, 2002

Question: I recently saw a pediatric patient whod been seen six months before by another member of my pulmonology group, who has since left. The childs parents requested a second opinion on the prognosis for their child, who had cystic fibrosis. I performed an extensive multisystem exam, reviewed the lengthy medical record, and spent 75 minutes counseling the parents. Should this patient be coded as a new patient?

Nevada Subscriber
 
Answer: This service meets the definition of a confirmatory consultation, 99271-99275. The patients parents requested the physicians opinion of an established diagnosis. Since another physician did not request this service, the standard consultation codes should not be reported. The physician providing this service may evaluate the patient and render an opinion based on his or her evaluation, but may not institute any diagnostic or therapeutic interventions.
 
If the pulmonologist requires additional diagnostic testing or initiates treatment, a confirmatory consult cannot be billed. In this case, an established patient visit (99211-99215) would be appropriate because the patient was seen in the practice within the preceding three years. In keeping with current documentation guidelines for consultations, a written communication must be sent to the party requesting the consult, in this case the patients parents.

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