In the hospital setting, following the initial consultation service, the subsequent hospital care procedure ? codes 99231-99233 should be reported for additional follow-up visits. These services need to be reported as subsequent visits with the appropriate place of service and level of service.Ģ. Ongoing management, following the initial consultation service by the consulting physician or other qualified health care professional should not be reported with consultation service codes. A consulting physician or other qualified health care professional may initiate diagnostic services and treatment at the initial consultation service or may even take over the patient’s care after the initial consultation.ġ. In the office or outpatient setting, the consultant should use the appropriate office or outpatient consultation procedure ? codes 99241-99245 for the initial consultation service.ģ. The initial inpatient consultation may be reported only once per consultant per patient per facility admission.Ģ. In the hospital and nursing facility setting, the consulting physician or other qualified health care professional shall use the appropriate inpatient consultation procedure ? codes 99251-99255 for the initial consultation service. Consultation is appropriate in any outpatient setting including the office, emergency department, home, or domiciliary setting.ġ. Office or Other Outpatient Consultations: Office or other outpatient consultations are reported with procedure codes 99241-99245 with no distinction between new and established patients. Typically, 80 minutes are spent face-to-face with the patient and/or family. Usually, the presenting problem(s) are of moderate to high severity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Typically, 60 minutes are spent face-to-face with the patient and/or family.ĩ9245 – 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 high complexity. Counseling 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. Typically, 40 minutes are spent face-to-face with the patient and/or family.ĩ9244 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. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-toface with the patient and/or family.ĩ9243 Office consultation for a new or established patient, which requires these 3 key components: A detailed history A detailed examination and Medical decision making of low complexity. Usually, the presenting problem(s) are of low severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.ĩ9242 Office consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history An expanded problem focused examination and Straightforward medical decision making. Usually, the presenting problem(s) are selflimited or minor. 99241 – Office consultation for a new or established patient, which requires these 3 key components: A problem focused history A problem focused examination and Straightforward medical decision making.
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