Family requested inpt 2nd opinion

lucrezia

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I have a consult my doc says it was requested by Dr. D, but in the body of the consult (and on the order sheet) it states "the family requests a second opinion".

Now I know I can't bill an inpatient consult because of the family request of the 2nd opinion, but can I bill subsequent hospital care as stated in CPT under the heading of hospital inpatient services? The doc has all the required documention for coding a level 2 inpt subsequent visit.

I'm confused about using those inpt subseq visits codes because this is the only time the doc saw the patient.

Thanks for any and all help!!
k
 

Lisa Bledsoe

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Unfortunately, the subsequent code is the only code you can use because of the "family requested second opinion", even though it's the first time your doctor is seeing the patient. I'm curious if your doctor and Dr. D are of the same specialty? Would they ever cover call for each other? That would be another scenerio where your doc might see a patient for the first time (and possibly only) but would have to code a subsequent visit...:)
 
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Are you sure it's family requested?

If the family told Dr D they wanted a second opinion, and then Dr D asked your doc for a consult/opinion, then it's still a consult, even if your doc states that the reason for the consult is that the family wanted a second opinion.

If the family went directly to your doc for a second opinion without any input from Dr D, then it's a subsequent visit.

Can you access the hospital chart to check for orders? In our hospital "consult requests" are ordered by the attending physician.

Hope that helps.
F Tessa Bartels, CPC, CPC-E/M
 
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