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Pulmonology Coding Alert

You Be the Coder:

Second Opinion for Cystic Fibrosis

Published on Sun Oct 12, 2003

Question: Our pulmonologist recently saw a pediatric patient with cystic fibrosis (277.02). The parents brought the child in for a second opinion after another physician in our practice examined him. The pulmonologist performed an extensive multisystem exam, reviewed the lengthy medical record and counseled the parents. Should I assign new patient or office consultation codes?

California Subscriber

Answer: To accurately report your pulmonologist's service, you must consider three factors:
 1. No physician or any physician in the same group practice should have performed an E/M service on a "new patient" for at least three years.

 2. You may, however, report consultation codes (99241-99245) for both new and established patients.

 3. A pulmonologist in the same group practice may provide a second opinion only if the consulting physician has a greater level of expertise than the first physician. If the consulting pulmonologist doesn't belong to the same practice, you don't have to consider the physician's expertise.
 
Because the patient's family, not the physician, requested the second opinion, you might also consider confirmatory consultation codes (99271-99275). But to report these codes, CPT guidelines require that your physician provide only his or her opinion. If your pulmonologist provided any diagnostic testing, for example, you couldn't report 99271-99275. In that case, report new or established patient codes (99201-99205
or 99211-99215).
 
To report 99271-99275, the physician's documentation must identify the service as a "second opinion" or "confirmatory consult." Also, the documentation should note that the patient requested the second opinion.

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