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General Surgery Coding Alert

Use Modifier -32 to Report Confirmatory Consults

Published on Fri Aug 15, 2003

Not every type of consult must meet the same requirements. Specifically, physicians providing consults to render second or third opinions can observe different "request" criteria, which can allow you to report these codes without the written request of another physician.
 
Although CMS guidelines as outlined in section 15506 of the Medicare Carriers Manual (MCM) state that "a physician or other appropriate source" must request a consultation, physicians may provide confirmatory consults (99271-99275) when a patient, the patient's family, or an insurer is seeking a second or third opinion prior to authorizing treatment - without another physician's written request.
 
If an insurer requests the consult to determine medical necessity prior to covering a procedure or service, you should report the appropriate confirmatory consult code (99271-99275, as supported by documentation) with modifier -32 (Mandated services) appended.
 
For example, surgeon "A" provides a diagnosis of stomach cancer and recommends immediate surgical treatment to remove the malignant tissue. The insurer, seeking a second opinion before authorizing costly surgery, requests a confirmatory consult with surgeon "B." Surgeon "B" evaluates the patient, provides a written response (for the insurer) and reports the confirmatory consult level supported by documentation (e.g., 99274) with modifier -32 appended. He or she may also separately report any required diagnostic testing.

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