This article will define CPT Code 99251, explain the medical necessity to report CPT 99251, the guidelines and clinical examples of CPT 99251.
CPT Code 99251 Description
CPT Code 99251 is defined by the CPT manual as follows (the text in Italic is the official definition of CPT 99251):
Inpatient consultation for a new or established patient, which requires these 3 key components:
- Component 1: A problem focused examination
- Component 2: A problem focused history
- 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 self-limited or minor.
Typically, 20 minutes are spent at the bedside and on the patient’s hospital floor or unit.
CPT 99251 Inpatient & Initial Consultations
Inpatient hospital consultations are reported with CPT codes 99251 – 99255. These CPT codes are used to report medical and other health care professional consultations given to inpatients, nursing facility residents, or patients in a partial hospital setting.
Within the hospital and nursing facility, the medical consultant or other qualified health care practitioner must use the appropriate CPT codes 99251 – 99255, which are the consultation codes for an initial consultation service. Initial inpatient consultation can only be reported once per consultant, patient and admission.
CPT Code 99251 Examples
Initial hospital consultation for a 27-year-old female with fractured incisor post-intubation. (Oral & Maxillofacial Surgery)
Initial hospital consultation for an orthopaedic patient on IV antibiotics who has developed an apparent candida infection of the oral cavity .(Oral & Maxillofacial Surgery)
Initial inpatient consultation for a 30-year-old female complaining of vaginal itching, post orthopaedic surgery. (Obstetrics & Gynaecology)
Initial inpatient consultation for a 36-year-old male on orthopaedic service with complaint of localised dental pain. (Oral & Maxillofacial Surgery)