Neurosurgery Coding Alert

If you're not using modifier -32 (Mandated services) for confirmatory consults, you're surgeon is probably forfeiting deserved reimbursement.
 
Physicians providing consults to render second or third opinions can observe different "request" criteria for their services, which can allow you to report these codes without the written request of another physician.
 
Although CMS regulations, outlined in section 15506 of the Medicare Carriers Manual, 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 appended.
 
For example, surgeon "A" provides a brain-tumor diagnosis 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) and appends modifier -32. He or she may also report separately any required diagnostic testing.