A third-party entity mandates a second-opinion evaluation that the clinic physician would not otherwise have performed. Which modifier concept signals mandated services on the professional claim?
Select an answer to reveal the explanation.
Short Explanation
When an insurer or other third party forces a visit that was not the clinic’s idea, you are not dressing it up as a same-day E/M or surgery-decision modifier. Modifier 32 is the ‘this was ordered from outside’ flag for mandated services.
Full Explanation
Modifier 32 indicates services related to mandated consultation and/or related services when a third party requires the service. It is distinct from modifier 25 (separately identifiable E/M with a procedure), modifier 57 (E/M resulting in the decision for major surgery), and modifier 33 (preventive services). Physician-office coders should use mandated-service reporting only when documentation shows the third-party requirement, not merely a routine second look the practice initiated.