CPT Code 99251 | Description & Clinical Information
CPT 99251 can be reported for consultation by a provider at the request of another provider. The three key components must be met to report this code and are an addition to the medical necessity.
1. Description
CPT Code 99251 is officially describe by the CPT manual as; “Inpatient consultation for a new or established patient, which requires these three key components:
- Straightforward medical decision-making;
- A problem-focused examination; and
- A problem-focused history.
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.
Usually, the presenting problem(s) are self-limited or minor. Typically, twenty minutes are spent at the bedside and on the patient’s hospital unit or floor.“
2. Procedure
During the 99251 CPT code procedure, a provider requests consultation from another provider.
Then, the provider spends twenty minutes on a face-to-face consultation with an established or new patient.
3. Billing Guidelines
The service level supported by CPT 99251 needs to meet all three key components described below.
The three key components required are a problem-focused examination, Straightforward medical decision-making, and a problem-focused history.
Be aware that the problems are often of minor severity or self-limited.
4. Resources
https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
