Reader Questions: Point Out Mandated Services With 32

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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 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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