The note must clearly state that greater than 50% of the total time was spent in counseling and/or coordination of care.Īn example of this documentation is as follows: Total visit 30 minutes, 20 minutes spent counseling patient on side ef ects of medication (99242). The content of the counseling and/or coordination of care must be documented.ģ. Total time of the visit must be documented.Ģ. The guidelines are very clear as to the proper way to document this occurrence. When is it appropriate to choose the level of E/M Consultation based on time? You may choose the level based on time when you have spent greater than 50% of the total time of the visit in counseling or coordination of care for your patient. Applicable FARS/DFARS apply.Ĭhoosing the level using Time as the deciding factor Italicized and/or quoted material is excerpted from the American Medical Association Current Procedural Terminology CPT codes, descriptions and other data only are copyrighted 1999 American Medical Association.
All of the criteria for the use of a consultation code are met.The CMS will pay a consultation fee when the service is provided by a physician at the request of the patient’s attending physician when: Physicians typically spend 30 minutes face-to-face with the patient and/or family. Usually, the presenting problem(s) are self limited or minor. an expanded problem focused examination and.Physicians typically spend 15 minutes face-to-face with the patient and/or family. straightforward medical decision makingĬounseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.Office consultation for a new or established patient, which requires these three key components: Consultation services in observation status are reported with the outpatient consultation codes ( 99241– 99245).The CMS concurs with American Medical Association “Current Procedural Terminology (CPT)” guidelines related to physician reporting of inpatient and outpatient consultation services 99241-99243, 99244-99255: Instead, you should code a patient evaluation and management (E&M) visit with E&M codes that represent where the visit occurs and that identify the complexity of the service performed.įor non-Medicare patients, if the consultation is done after the patient is admitted to the hospital, consultation services may be reported with the inpatient consultation codes (99251–99255). Medicare no longer pays for the CPT consultation codes (ranges 99241-9921-99255). Likewise, is 99244 covered by Medicare? On January 1, 2010, Medicare eliminated consultation codes for both hospital and office visits. The Current Procedural Terminology ( CPT) code 99244 as maintained by American Medical Association, is a medical procedural code under the range - New or Established Patient Office or Other Outpatient Consultation Services.ĬPT CODE and Description 99244 - Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history A comprehensive examination and Medical decision making of moderate complexity. CPT 99244, Under New or Established Patient Office or Other Outpatient Consultation Services.