cpt 99252

CPT Code 99252 | Description, Procedure & Billing Guidelines

CPT 99252 can be billed for inpatient consultation services provided at another provider’s request. Three key components must be met and are an addition to the medical necessity.

1. Description

CPT Code 99252 is defined by the CPT manual as follows: Inpatient consultation for a new or established patient, which requires these three key components:

  1. Straightforward medical decision-making.
  2. An expanded problem-focused history; and
  3. An expanded problem-focused examination.

Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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. Typically, 40 minutes are spent at the bedside and on the patient’s hospital floor or unit.”

2. Procedure

During the 99252 CPT code procedure, the health provider requests consultation services from another provider. This provider provides inpatient consultation with an established or new patient.

The total time spent the provider spent on consultation is forty minutes.

3. Billing Guidelines

CPT 99252 can only be reported if all three components are met. The problems that are present are often of low severity.

The three components that need to be met are:

  1. Straightforward medical decision–making.
  2. An expanded problem–focused examination.
  3. An expanded problem–focused history.

4. Resources

https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf

http://www.cms.gov/files/document/physician-fee-schedule-pfs-payment-officeoutpatient-evaluation-and-management-em-visits-fact-sheet.pdf

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