READER QUESTION: Patient-Generated Second Opinion Isn't a Consult

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This reader Q&A discusses how second-opinion services are handled after deletion of the confirmatory consult codes, and it outlines the general E/M categories that may apply in office and facility settings. It is relevant for coders, billers, and clinicians who need to distinguish between patient-requested second opinions and rare physician-arranged consultation scenarios under CMS guidance.

Why This Topic Matters

Second-opinion visits can be misclassified if they are assumed to be consults. Understanding the article helps practices choose the correct general E/M pathway and recognize when CMS facility-setting consultation guidance may come into play.

Article Sections

  1. Question

    The reader asks how to report surgeon services for a second opinion after deletion of confirmatory consult codes.

  2. Answer

    The response addresses general E/M reporting for patient-requested second opinions and notes the distinction between routine office visits and rare consultation scenarios.

  3. Caveat

    This section notes an uncommon physician-generated second-opinion scenario that may fit consultation reporting in a facility setting.

  4. CMS Transmittal 788, dated Dec. 20, 2005

    A quoted CMS transmittal provides facility-setting guidance on reporting second-opinion consultations and alternative subsequent-care reporting when consultation requirements are not met.

What You Will Learn

  • How the article frames second-opinion services in relation to office E/M reporting
  • When a second opinion may be treated differently in a facility setting
  • What CMS guidance is referenced for consultation-related facility reporting
  • Which general code families are discussed for new, established, inpatient, and nursing facility care

Who Should Read This

  • Medical coders
  • Billing staff
  • Practice managers
  • Surgeons
  • Physician office staff

Codes Discussed

Code Ranges Discussed


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