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Consultation Codes Update | CPT 99242-99245, 99252-99255 Consultation Codes First, CMS stopped recognizing consult codes in 2010 Outpatient consultations (99241—99245) and inpatient consultations (99251—99255) were still active CPT ® codes, and depending on where you are in the country, are recognized by a payer two, or many payers In 2023, codes 99241 and 99251 are deleted
How to Bill a Consultation at the Hospital (Inpatient) Medicare doesn’t accept codes (99251-99255) use (99221-99223) instead The correct inpatient consultation codes for a first evaluation are 99221-99223 These codes are used for the inpatient History and Physical (H P), as well as any specialty consultation (limited to one visit from each specialty)
2 new codes developed for interprofessional consultation Current Procedural Terminology (CPT) codes 99446-99449 were created in 2014 to capture the time spent by a consultant who is not in direct contact with the patient at the time of service An interprofessional telephone internet consultation (ITC) is defined as an assessment and management service in which a patient’s treating (e g , attending or primary) physician other qualified health care
Medical Coding and Billing for Consultations Explore medical coding and billing for consultations, including CPT and ICD-10 codes, documentation, and tips for accurate reimbursement and regulatory compliance
2023 CPT E M descriptors and guidelines A “consultation” initiated by a patient and or family, and not requested by a physician, other qualified health care professional, or other appropriate source (eg, non-clinical social worker, educator, lawyer, or insurance company), is not reported using the consultation codes
2023 Changes to the Inpatient and Consultation E M Codes CMS instructs physicians and qualified healthcare professionals (QHPs) to use new and established Office or Other Outpatient Codes for consultations when the patient is in observation status CPT states to use the Inpatient and Observation Care consultation codes (99252 to 99255) for consultations during an observation stay
CPT Code 99242: Office or Outpatient Consultation for a New . . . What is CPT code 99242? CPT code 99242 is an evaluation and management (E M) code for office or other outpatient consultations provided to a new or established patient It involves a straightforward medical decision-making level or requires a total of at least 20 minutes on the encounter date Typically used by physicians or other qualified health care professionals, 99242 applies when another