This article will define CPT Code 99241, explain the medical necessity to report CPT 99241, the guidelines and clinical examples of CPT 99241.
CPT Code 99241 Description
CPT Code 99241 is defined by the CPT manual as follows (the text in Italic is the official definition of CPT 99241):
Counselling and / or coordination of care with other providers or facilities is done according to the nature of the problems and the needs of the patient and / or family. Usually the problems that occur are self-limited or minor.
Office consultation for a new or established patient that requires these three key components:
- Component 1: A problem-focused history
- Component 2: A problem-focused examination
- Component 3: Straightforward medical decision-making
Doctors typically spend 15 minutes face-to-face with the patient and / or family. Before using CPT code 99241, you can understand what advisory codes are.
CPT 99241 Consultation Code
The follow is for CPT codes 99241 – 99245. Consultation coding is used to represent second opinion visits. Consultation is a class of assessment and management service given by a physician at the request of a second physician or other necessary source, either to recommend treatment for a particular illness or problem, or to resolve whether he should be responsible for continuous treatment of the patient or for the care of a specific condition or problem. It does not serve as a code of conduct for assessment and management, or related advice.
Effective from 1st October 2017, United Healthcare will no longer reimburse for consulting services represented by CPT codes 99241 – 99245 and CPT codes 99251 – 99255. United Healthcare reimburses for the needed assessment and administrative process (E / M) code that explains the practice visit, the hospital care codes reported in lieu of a counseling service regulation.
Cigna is the most recent payer to declare that consulting services will no longer be reimbursed as of 19th October 2019. Consulting services formerly represented by CPT codes 99241 – 99245 and CPT codes 99251 – 99255 must be provided using the Evaluation and Administrative Procedure Code (E / M) corresponding to the practice visit, hospital care, care center, home service, or home / nursing care.
Billing Guidelines CPT Code 99241
The following guidelines are to help you determine if you entitle to use a warning CPT code 99241 – 99245. Documentation must contain the following evidence:
- Advice from a third party
- Need for advice on the patient’s medical record
- A specialist consultation
- Provision of a specialised alternative doctor or practitioner, whose advice, opinion, recommendation, proposition, guidance or advice is obtained for evaluation and treatment
- Recommendations of a patient, since this exceeds the professional competence of the person in a certain medical field, the awareness of the requesting physician or alternate physician.
- Delivery of a written report / specialist recommendations to the referring physician or alternate physician
- Advisory codes should not be billed continuously or if consultation is patient / family initiated.
2021 Updates For Reporting Consultation Codes
If you are reporting an inquiry (CPT 99241 – 99245 and CPT 99251 – 99255) to a payer that recognises the tips, use the 1995 – 1997 guidelines to choose a level of service.
CPT Code 99241 Examples
Initial office consultation for a 40-year-old female in pain from blister on lip following a cold. (Oral & Maxillofacial Surgery)
Initial office consultation for a 62-year-old construction worker with olecranon bursitis. (Orthopaedic Surgery)
Office consultation with 25-year-old postpartum female with sever symptomatic haemorrhoids. (Colon & Rectal Surgery)
Office consultation with 58-year-old male, referred for follow-up of creatinine level and evaluation of obstructive Uropathy, relieved two months ago. (Nephrology)
Office consultation for 30-year-old female tennis player with sprain or contusion of the forearm. (Orthopaedic Surgery)
Office consultation for a 45-year-old male, requested by his internist, with asymptomatic torus palatines requiring no further treatment. (Oral & Maxillofacial Surgery)