CPT code 99245 covers an office or other outpatient consultation service for a new or established patient that requires high-level medical decision-making and at least 55 minutes of total time spent on the encounter on a single date.
What Is CPT Code 99245?
CPT 99245 describes an office or other outpatient consultation service for a new or established patient. The total time of the encounter needs to be 55 minutes or more.
You can only use this code for patients who require a higher level of medical attention and decision-making.
The service requires a medically appropriate history and/or examination and a high level of medical decision-making.
The service involves taking a patient history. The provider gathers information about the patient’s medical condition and past medical history.
This information is used to understand the patient’s condition and to make informed decisions about their care and treatment.
99245 also includes a physical examination. This is an examination of the patient’s body to identify any abnormalities or issues affecting their health.
A high level of medical decision-making refers to the complexity of the patient’s condition and the amount of data that needs to be reviewed and analyzed to make informed decisions about their care and treatment.
This may include the number and complexity of problems addressed, the amount and/or complexity of data to review and analyze, and the risk of complications, morbidity, and mortality related to patient management.
The CPT book describes CPT code 99245 as: “Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.”
A provider performs an evaluation and management (E/M) consultation service for a patient in an office or other outpatient setting.
This service is used for patients requiring a high level of medical attention and decision-making.
The service involves a high level of medical decision-making or a total of at least 55 minutes spent on the encounter on a single date.
The total time spent on the encounter includes both face-to-face and non-face-to-face activities such as;
- reviewing tests,
- ordering tests;
- interpreting and communicating results;
- coordinating care;
- documenting the encounter;
- counseling and educating the patient or caregiver;
- preparing for the patient visit;
- communicating with other healthcare providers; and
- performing the exam or evaluation
These activities are necessary to ensure that the patient receives the best care and treatment.
The service may also include taking a patient history and performing a physical examination as appropriate.
The provider determines the nature and extent of the history and/or exam appropriate for the encounter to gather all the necessary information about the patient’s condition and to understand their medical history.