cpt 99253

CPT Code 99253 – Description & Clinical Examples

This article will define CPT Code 99253, explain the medical necessity to report CPT 99253, the guidelines and clinical examples of CPT 99253.

CPT Code 99253 Description

CPT Code 99253 is defined by the CPT manual as follows (the text in Italic is the official definition of CPT 99253):

Inpatient consultation for a new or established patient, which requires these 3 key components: 

  • Component 1: A detailed history
  • Component 2: A detailed examination
  • Component 3: Medical decision making that is of low complexity

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 problem(s) requiring admission are of low severity.

Physicians typically spend 55 minutes at the bedside and on the patient’s hospital floor or unit.

The following points are the minimum you need to do to qualify for a hospital visit CPT code 99253. These guidelines are very identical to the low hospital admission codes CPT 99221, 99218 and 99234, but there are some slight comparisons, unlike the consultation codes CPT 99254 – 99255, which need the equal E / M criteria as their respective admission / first visit codes. They require a medical history, physical examination and decision making to entitle their respective levels, unlike the hospital follow-up exams that only require 2 out of 3 areas.

  1. History
    – 4 elements of the HPI: character, location, onset, duration and associated signs, the status of 3 chronic medical conditions.
    – 2 review of the systems
    – 1 area from Medications, Past Medical, Allergies, Social History, Family
  2. Exam
    – Extended exam of the affected body area and other symptomatic or related organ systems, 6 areas or an additional 2 areas.
  3. Decision Making
    – Diagnosis: 2 points
    – Data: 2 points
    – Risk: Low

CPT Code 99253 Examples

Example 1

Initial hospital consultation for 50-year-old female with incapacitating knee pain due to generalized rheumatoid arthritis. (Orthopeadic Surgery)

Example 2

Initial hospital consultation for a 60-year-old male with avascular  necrosis of the left femoral heel with increasing pain. (Orthopaedic Surgery)

Example 3

Initial hospital consultation for a 45-year-old female with compound mandibular fracture and concurrent head, abdominal, and/or orthopaedic injuries. (Oral & Maxillofacial)

Example 4

Initial hospital consultation for a 22-year-old female, paraplegic, to evaluation wrist and hand pain. (Orthopaedic Surgery)

Example 5

Initial hospital consultation for a 40-year-old male with 10-day history of incapacitating unilateral sciatica, unable to walk now, not improved by bed rest. (Neurosurgery)

Example 6

Initial hospital consultation, requested by pediatrician, for treatment recommendations for a patient admitted with persistent inability to walk following soft tissue injury to ankle. (Physiatry)

Example 7

Initial hospital consultation for a 27-year-old previously healthy male who vomited during IV sedation and may have aspirated gastric contents. (Anesthesiology)

Example 8

Initial hospital consultation for a 33-year-old female, post-abdominal surgery, who now has a fever. (Internal Medicine)

Example 9

Initial inpatient consultation for a 57-year-old male, post lower endoscopy, for evaluation of abdominal pain and fever. (General Surgery)

Example 10

Initial inpatient consultation for rehabilitation of a 73-year-old female one week after management of a hip fracture. (Physical Medicine & Rehabilitation)

Example 11

Initial inpatient consultation for diagnosis/management of fever following abdominal surgery. (Internal Medicine)

Example 12

Initial inpatient consultation for a 35-year-old female with a fever and pulmonary infiltrate following cesarean section. (Pulmonary Medicine)

Example 13

Initial inpatient consultation for a 42-year-old non-diabetic patient, postoperative cholecystectomy, now with an acute urinary tract infection. (Nephrology)

Example 14

Initial inpatient consultation for 53-year-old female with moderate uncomplicated pancreatitis. (Gastroenterology)

Example 15

Initial inpatient consultation for 45-year-old patient with chronic neck pain with radicular pain of the left arm. (Orthopaedic Surgery)

Example 16

Initial inpatient consultation for 8-year-old patient with new onset of seizures who has a normal examination and previous history. (Neurology)

Similar Posts

Leave a Reply

Your email address will not be published.