A consultation is a sort of evaluation and management service that is offered at the request of another physician, another competent healthcare expert, or a suitable source to propose therapy for a specific ailment or issue. Diagnostic and/or therapy treatments may be initiated by a physician or other certified health care professional consultant during the same or subsequent visit.

A “consultation” started by a patient and/or family and not solicited by a physician or other healthcare provider. The consultation codes do not include qualified healthcare professionals or other suitable sources (for example, non-clinical social workers, educators, lawyers, or insurance companies). The consultant’s opinion and any services requested or done must be disclosed to the requesting physician, other qualified health care provider, or another suitable source in writing.

Office or Other Outpatient Consultations

The following codes can be used to describe consultations delivered at an office or other outpatient setting, such as a patient’s home or residence, or in an emergency room. Follow-up visits started by the consultant or patient at the consultant’s office or other outpatient facility are recorded using the relevant codes for established patients in the office (99212, 99213, 99214, 99215) or home or residence (99212, 99213, 99214, 99215). (99347, 99348, 99349, 99350). Transfer of care services (those given for managing the patient’s overall care or treating a specific ailment or issue) is documented using the relevant new or existing patient codes for office or other outpatient visits or home or residence services. (Use 99417) for an outpatient consultation needing extended services. (99241) was removed. To report, dial 99242).

99242 An office or other outpatient consultation for a new or existing patient that involves a medically adequate history and/or examination, as well as easy medical decision-making. When considering the total time on the day of the encounter to choose a code, the time limit of 20 minutes must be fulfilled or surpassed.

99243 An office or other outpatient consultation for a new or existing patient requiring a medically adequate history and/or examination as well as a low degree of medical decision-making. When selecting a code based on total time on the day of the encounter, 30 minutes must be reached or surpassed.

99244 An office or other outpatient consultation for a new or established patient that necessitates a medically adequate history and/or examination, as well as a moderate level of medical decision-making. When utilizing the total time on the encounter date for code selection, 40 minutes must be fulfilled or surpassed.

99245 A new or existing patient who requires a medically appropriate history and/or examination, as well as a high degree of medical decision-making, may necessitate an office or other outpatient consultation. If the total time on the day of the encounter is used for code selection, 55 minutes must be reached or surpassed. (For services lasting 70 minutes or more, use service code 99417).

Inpatient or Observation Consultations

Codes 99252, 99253, 99254, and 99255 are used to report physician or other qualified health care professional consultations provided to hospital inpatients, observation-level patients, nursing facility residents, or patients in a partial hospital setting, and when the patient has not received any face-to-face professional services from the exempt physician or other qualified health care professional. When advanced practice nurses and physician assistants collaborate with physicians, they are regarded to be practicing in the same specialty and specialization as the physician. A consultant may report just one consultation per admission.

99252 Inpatient or observation consultation for a new or existing patient requiring a medically adequate history and/or assessment and simple medical decision-making. When considering the total time on the day of the encounter to choose a code, the time limit of 35 minutes must be fulfilled or surpassed.

99253 Inpatient or observation consultation for a new or existing patient that necessitates a medically adequate history and/or examination as well as a low degree of medical decision-making. When utilizing the total time on the encounter date for code selection, 45 minutes must be fulfilled or surpassed.

99254 Inpatient or observation consultation for a new or existing patient that necessitates a medically adequate history and/or examination, as well as a moderate degree of medical decision-making.

99255 Inpatient or observation consultation for a new or existing patient requiring a medically appropriate history and/or examination, as well as a high degree of medical decision-making.

Emergency Department Services

The following codes are used to report assessment and management services delivered in the emergency department. In the emergency department, there is no distinction between new and existing patients. An emergency department is a hospital-based facility that provides unplanned episodic services to individuals who require rapid medical assistance. The facility must be open 24 hours a day.

See Critical Care Guidelines and 99291, 99292 for information on emergency department critical care services. Critical care and emergency department services may be recorded on the same day if the patient’s condition changes after the emergency department service and critical care services are performed.

See 99221, 99222, 99223 for the initial observation encounter and 99231, 99232, 99233, 99238, 99239 for subsequent or discharge hospital inpatient or observation visits for assessment and management services provided to a patient in observation status. See 99234, 99235, and 99236 for hospital inpatient or observation care services (including admission and release).

To record services when a patient is admitted to a hospital inpatient or observation status, or to a nursing facility in the course of an interaction in another environment, see Initial Hospital Inpatient or observation Care or Initial Nursing Facility Care.

99281 A visit to the emergency department for the examination and management of a patient that does not necessitate the presence of a physician or other certified health care provider.

99282 Visit to an emergency department for the assessment and care of a patient that necessitates a medically adequate history and/or examination as well as unambiguous medical decision-making.

99283 An emergency department visit for the evaluation and care of a patient that necessitates a medically adequate history and/or examination as well as a low degree of medical decision-making.

99284 An emergency department visit for the assessment and care of a patient that necessitates a medically acceptable history and/or examination as well as a moderate level of medical decision-making.

99285 Visit to an emergency department for the assessment and care of a patient that necessitates a medically appropriate history and/or examination as well as a high degree of medical decision-making.