Orthopedic Coding Alert

Question: If a patient is in the postoperative period for a diagnostic knee arthroscopy, can the primary physician still ask for a second opinion, and can the other surgeon bill for that second opinion? He is from our same practice. Im also unclear as to the rules for second opinions postoperatively.

Texas Subscriber

 
Answer: The office or other outpatient consultation codes 99241-99245 apply in this case. The majority of payers, including Medicare, will reimburse for a consultation between two doctors in the same practice, as long as all the criteria for a consultation are met, including the request for an opinion, no transfer of care and a letter in the file acknowledging that the consultation took place. For the complete CMS guidelines on consultations, refer to the Medicare Carriers Manual, Part 3, Chapter XV, Section 15506.