CPT Code 99242 Description
CPT Code 99242 is defined by the CPT manual as follows (the text in Italic is the official definition of CPT 99242):
Office consultation for a new or established patient which requires these three key components:
- Component 1: An expanded problem-focused history
- Component 2: An expanded problem-focused examination
- Component 3: A straightforward medical decision making
Counselling 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. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family.
Consultation CPT codes are 99241 – 99245 are used to show second opinion visits. Consultation is a sort of evaluation and management (E / M) service provided by a doctor at the request of another doctor or other appropriate source, either to recommend treatment for a particular condition or problem, or to determine whether they’re should be responsible for continuous treatment. It does not serve as a CPT code for E / M, or related counselling.
Evaluation & Management Consultation Codes
When to code an evaluation and management (E / M) service as a consultation is a commonly discussed query in determining if an E / M service is a consultation. The discreet variation between a consultation and an office visit is that the consultation is performed by a doctor whose knowledge or advice regarding E / M of a particular problem is sought from another doctor. A visit to the doctor is considered a consultation only if the following criteria are met for the use of a consultation code:
- The consultation is made at the request of another physician or an appropriate source seeking advice on E / M on a particular problem.
- The request for a consultation and the purpose of the request must be noted in the medical history record of the patient.
- Post-consultation, the doctor must prepare a written report that is sent to the referring doctor.
When the above requirements are not completed then the appropriate office or other outpatient (CPT codes 99201 – 99215) or hospital inpatient (CPT code 99221 – 99223) E / M service can be reported in contrary to a consultation CPT code.
CPT Code 99242 Examples
Initial office consultation for a 20-year-old male with acute upper respiratory tract symptoms. (Allergy & Immunology)
Initial office consultation for a 29-year-old soccer player with painful proximal thigh/groin injury. (Orthopaedic Surgery)
Initial office consultation for a 66-year-old female with wrist and hand pain, numbness of finger tips, suspected median nerve compression by carpal tunnel syndrome. (Plastic Surgery)
Initial office consultation for a patient with a solitary lesion of discoid lupus erythmatosus on left cheek to rule out malignancy or self-induced lesion. (Dermatology)
Office consultation for management of systolic hypertension in a 70-year-old male scheduled for elective prostate resection. (Geriatrics)
Office consultation with 27-year-old female, with old amputation, for evaluation of existing above-knee prosthesis. (Physical Medicine & Rehabilitation)
Office consultation with 66-year-old female with wrist and hand pain, and finger numbness, secondary to suspected carpal tunnel syndrome. (Orthopaedic Surgery)
Office consultation for 61-year-old female, recently on antibiotic therapy, now with diarrhea and leukocytosis. (Abdominal Surgery)
Office consultation for a patient with papulosquamous eruption of elbow with pitting of nails and itchy scalp. (Dermatology)
Office consultation for a 30-year-old female with single season allergic rhinitis. (Allergy & Immunology)