Outpatient Facility Coding Alert - 2007 Issue 1
READER QUESTION: Patient-Generated Second Opinion Isn't a Consult
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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
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Question
The reader asks how to report surgeon services for a second opinion after deletion of confirmatory consult codes.
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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.
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Caveat
This section notes an uncommon physician-generated second-opinion scenario that may fit consultation reporting in a facility setting.
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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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