Advanced Search

Oncology & Hematology Coding Alert

Reader Question:

Keep Away From Consult Code for Second Opinion

Published on Thu Mar 01, 2007

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

Florida Subscriber


Answer: You may think this 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.

Example: A patient requests an appointment to get a second opinion on the treatment course her physician suggested. At the appointment, your practice's oncologist meets the requirements to report 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three 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 the payer.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Oncology & Hematology Coding Alert

View All