Wiki Second Opinion by physician

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demassd

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I have a surgeon who was asked by a patient for a second opinion on a mamogram. The physician did a full exam and did her own mamogram. She charged a consultation with findings of lumps in her breast. The patient calls and states that her insurance wont pay this consult code and wants us to code as a screening code. Please help!:(
 
Consults cannot be patient initiated. A patient is not considered to be an appropriate requesting source for a consult service. If the patient is requesting a second opinion, then the guidelines stipulate the visit should be reported with the appropriate problem-oriented office E/M level. If the patient was seeking the second opinion because of a complaint and the mammogram is diagnostic in nature (as it appears to be based on your question with the diganosis of lumps in the breast), then you would report the appropriate problem-oriented E/M level (99201-99215).

Hope this helps and this is my opinion.
 
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