Outpatient Facility Coding Alert - 2015 Issue 6
Reader Questions: Point Out Mandated Services With 32
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Article Overview
This short reader Q&A discusses a consultation coding scenario in which a payer-requested second opinion leads to discussion of an informational modifier and an office consultation E/M service. It is relevant to coders, billers, and compliance staff who handle consultation claims, workers’ compensation cases, and payer-specific reporting requirements.
Why This Topic Matters
Understanding when a claim involves a mandated service can affect how consultation-based professional services are reported to payers. The article also helps readers recognize the broader context of consultation billing and payer-requested services without relying on the full premium explanation.
What You Will Learn
- How a workers’ compensation consultation scenario is framed for coding discussion
- The role of an informational modifier in payer-requested services
- How consultation-based evaluation and management services are presented in the article
- The general distinction between payer-mandated and patient-requested consultations
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Practice managers
- Orthopedic office staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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