This article will define CPT Code 99252, explain the medical necessity to report CPT 99252, the guidelines and clinical examples of CPT 99252.
CPT Code 99252 Description
CPT Code 99252 is defined by the CPT manual as follows (the text in Italic is the official definition of CPT 99252):
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 severity.
Inpatient consultation for a new or established patient, which requires these 3 key components:
- Component 1: An expanded problem focused history
- Component 2: A Straightforward medical decision making
- Component 3: An expanded problem focused examination
Typically, 40 minutes are spent at the bedside and on the patient’s hospital floor or unit.
CPT Code 99252 Examples
Initial hospital consultation for a 45-year-old male, previously abstinent alcoholic, who relapsed and was admitted for management of gastritis, The patient readily accepts the need for further treatment. (Addiction Medicine)
Initial hospital consultation for a 35-year-old dialysis patient with episodic oral ulcerations. (Oral & Maxillofacial Surgery)
Initial preoperative consultation for a 43-year-old women with cholecystitis ICD 10 and well-controlled hypertension. (Cardiology)
Initial inpatient consultation for recommendation of antibiotic prophylaxis for a patient with a synthetic heart valve who will undergo urologic surgery. (Internal Medicine)
Initial inpatient consultation for possible drug induced skin eruption in 50-year-old male. (Dermatology)
Preoperative inpatient consultation for evaluation of hypertension in a 60-year-old male will undergo a cholecystectomy. Patient had a normal annual check-up in your office four months ago. (Internal Medicine)
Initial inpatient consultation for 66-year-old patient with wrist and hand pain and finger numbness, secondary to carpal tunnel syndrome.(Orthopaedic Surgery/Plastic Surgery)
Initial inpatient consultation for a 66-year-old male smoker referred for pain management immediately status post-biliary tract surgery done via sub-costal incision. (Anesthesiology/Pain Medicine)