CPT 99255 can be billed for consultation services at the request of another provider. This code can only be reported for inpatient consultation if the three components are met.
CPT Code 99255 is described by the CPT manual as follows: “Inpatient consultation for a new or established patient, requiring three key components:
- Medical decision-making of high complexity.
- A comprehensive examination; and
- A comprehensive history;
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 moderate to high severity. Typically, 110 minutes are spent at the bedside and on the patient’s hospital floor or unit.“
First, a provider requests another provider to provide inpatient consultation services for a new or established patient.
Then, the provider spends (on average) 110 minutes with the patient on the hospital’s unit or floor. The consultation services are all face-to-face.
3. Billing Guidelines
All three key components must be met to report CPT 99255 correctly. Namely;
- A comprehensive examination;
- A comprehensive history; and
- Medical decision–making of high complexity.
The problems are normally of high or moderate severity.