This article will define CPT Code 99244, explain the medical necessity to report CPT 99244, the guidelines and clinical examples of CPT 99244.
CPT Code 99244 Description
CPT Code 99244 is defined by the CPT manual as follows (the text in Italic is the official definition of CPT 99244):
Office consultation for a new or established patient that requires these three key components:
- Component 1: A comprehensive history
- Component 2: A comprehensive examination
- Component 3: Medical decision-making of moderate complexity
Counselling and/or coordination of care with other providers or agencies is 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 moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family.
Before using CPT 99244 let us determine what consultation codes are.
CPT 99244 Consultation Code
Consultation codes CPT 99244, 99245 and 99241 are used to represent second opinion visits. Consultation is a sort of assessment and management service given by a physician at the request of another physician or other appropriate source, either to recommend treatment for a particular condition or problem, or to define whether they should be responsible for ongoing treatment. It does not serve as a CPT code of conduct for assessment and management, or related advice.
When to code an evaluation and management (E / M) service as advice is one of the most commonly asked questions: How can you define if an E / M service is advice? The discreet comparison between a consultation and an office visit is that the consultation is performed by a doctor whose opinion or advice to evaluate and / or treat a particular problem is sought from another doctor. An office visit is considered a consultation only if the following criteria are met for the use of a consultation CPT code:
- The consultation is conducted at the request of another physician or a suitable source who is seeking assessment advice and / or handling of a certain problem.
- The request for advice and the logic for the request must be noted in the patient’s medical history.
- Post consultation, the physician must arrange a written report which is sent to the referring physician.
If all of the previous requirements are not met, the applicable practice or other E / M service for outpatient (CPT 99201 – 99215) or inpatient (CPT 99221 – 99223) should be reported in lieu of a consultation code.
CPT Code 99244 Examples
Initial office consultation for a 28-year-old male, HIV+, with a recent change in visual acuity. (Ophthalmology)
Initial office consultation for a 15-year-old male with failing grades, suspected drug abuse. (Pediatrics)
Initial office consultation for a 36-year-old factory worker, status four months post-occupational low back injury and requires management of intractable low back pain. (Pain Medicine)
Initial office consultation for a 45-year-old female with a history of chronic arthralgia of TMJ and associated myalgia and sudden progressive symptomatology over last two to three months. (Oral & Maxillofacial Surgery)
Initial office consultation for evaluation of a 70-year-old male with appetite loss and diminished energy. (Psychiatry)
Initial office consultation for an elementary school-aged patient, referred by pediatrician, with multiple systematic complaints and recent onset of behavioral discontrol. (Psychiatry)
Initial office consultation for a 23-year-old female with developmental facial skeletal anomaly and subsequent abnormal relationship of jaw(s) to cranial base. (Oral & Maxillofacial Surgery)
Initial office consultation for a 45-year-old myopic patient with a one-week history of floaters and a partial retinal detachment. (Ophthalmology)
Initial office consultation for a 65-year-old female with moderate dementia, mild unsteadiness, back pain fatigue on ambulation, intermittent urinary incontinence. (Neurosurgery)
Initial office consultation for a 33-year-old female referred by endocrinologist with amenorrhea and galactorrhea, for evaluation of pituitary tumor. (Neurosurgery)
Initial office consultation for a 34-year-old male with new onset nephritic syndrome. (Nephrology)
Initial office consultation for a 39-year-old female with intractable chest wall pain secondary to metastatic breast cancer. (Anaesthesiology/Pain Medicine)
Initial office consultation for a patient with multiple giant tumors of jaws. (Oral & Maxillofacial Surgery)
Initial office consultation for a patient with a failed total hip replacement with loosening and pain upon walking. (Orthopaedic Surgery)
Initial office consultation for a 60-year-old female with three-year history of intermittent tic-like unilateral facial pain; now constant pain for six weeks without relief by adequate carbamazepine dosage. (Neurosurgery)
Initial office consultation for a 45-year-old male heavy construction worker with prior lumbar disk surgery two years earlier; now gradually recurring low back and unilateral leg pain for three months, unable to work for two weeks. (Neurosurgery)
Initial office consultation of patient who presents with a 30-year history of smoking and right neck mass. (Otolaryngology/Head & Neck Surgery)
Office consultation with 38-year-old female, with inflammatory bowel disease, who now presents with right lower quadrant pain and suspected intra-abdominal abscess. (General Surgery/Colon & Rectal Surgery)
Office consultation with 72-year-old male with oesophageal carcinoma, symptoms of dysphagia and reflux. (Thoracic Surgery)
Office consultation for disease of treatment options for a 40-year-old female with a 2cm adenocarcinoma of the breast. (Radiation Oncology)
Office consultation for young patient referred by paediatrician because of patient short attention span, easy distractibility, and hyperactivity. (Psychiatry)
Office consultation for 66-year-old female, history of colon resection for adenocarcinoma six year earlier, now with severe mid-back pain; X-ray showing osteoporosis and multiple vertebral compression fractures. (Neurosurgery)
Office consultation for a patient with chronic pelvic inflammatory disease who now has left lower quadrant pain with a palpable pelvic mass. (Obstetrics & Gynaecology)
Office consultation for a patient with long-sanding psoriasis with acute onset of erythroderma, pustular lesions, chills, and fever, Combinations of topical and systemic treatments discussed and instituted. (Dermatology)