Cardiology Coding Alert


Steer Clear of Consult Code for Second Opinion

Question: Which CPT code should we report when a patient comes to our cardiologist for a second opinion?

Florida Subscriber

Answer: You may think this visit sounds like a consult, but you shouldn't use consultation codes (99241- 99255) to report this visit. Instead you should report the appropriate office (or hospital) visit code. (And if CMS has its way, you won't be reporting consult codes for any Medicare patients in 2010. See "38 Percent Cut for 93015? Ride 3 CMS Releases' Ups and Downs" in Cardiology Coding Alert, Vol. 12, No. 10, for more details.)

Example: A patient requests an appointment to get a second opinion on the treatment course her physician suggested. At the appointment, your practice's cardiologist meets the requirements to report 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity ...).

Watch for: Append modifier 32 (Mandated services) when the patient evaluation is part of a "second opinion program" required by a payer that recognizes the modifier.

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