decisionhealth Newsletters, Answer Books - 2008 Issue 12 (December)
Answer_Book / Consults,_Visits,_Referrals / Second_opinions_vs_Consults
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Article Overview
This article covers the Medicare distinction between second opinions and consults, including who may request the service and the broad billing settings where second-opinion services may be reported. It is relevant for physicians, NPPs, coders, and billing staff working with consults, visits, and referral-related encounter coding in hospital, nursing facility, and outpatient settings.
Why This Topic Matters
Understanding how second opinions differ from consults affects whether an encounter is billed as a consult or as another type of visit in the applicable care setting. The article is useful for reducing misclassification in common evaluation and management scenarios.
What You Will Learn
- How Medicare distinguishes second opinions from consult services at a high level.
- Which care settings are discussed for second-opinion billing.
- Which broad visit categories are referenced for hospital, nursing facility, and outpatient encounters.
- How modifier-related payer issues are discussed in the context of second opinions.
Who Should Read This
- Physicians
- Non-physician practitioners
- Medical coders
- Billing staff
- Practice managers
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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