What does CPT code 99244 mean? (2023)

What does CPT code 99244 mean?

CPT Code Description 99244 Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity.

If a visit (99244) is placed as telemedicine, then it is appropriate to append modifier 95 for telehealth services for physician services.

The Current Procedural Terminology (CPT^®) code 99242 as maintained by American Medical Association, is a medical procedural code under the range - New or Established Patient Office or Other Outpatient Consultation Services.

CPT® Code 99243 - New or Established Patient Office or Other Outpatient Consultation Services - Codify by AAPC.

Medicare no longer pays for the CPT consultation codes (ranges 99241-99245 and 99251-99255). Instead, you should code a patient evaluation and management (E&M) visit with E&M codes that represent where the visit occurs and that identify the complexity of the service performed.

The 99244 ranked 46th among the most frequently used CPT codes by all physicians in 2003. The reimbursement for this level of care is approximately $168.00. Usually the presenting problems are of moderate to high severity. Or 60 minutes spent face-to-face with the patient if coding based on time.

It is true that an evaluation and management code, an E/M or office visit, can be reported with a minor procedure such as an injection, but only if the E/M is significant and separate and exceeds the “pre-service evaluation” that is inherent to the injection.

Modifier 59 should be used to distinguish a different session or patient encounter, or a different procedure or surgery, or a different anatomical site, or a separate injury. It should also be used when an intravenous (IV) protocol calls for two separate IV sites.

As long as service is clearly documented and distinct from the documentation of the preventive service, CPT suggests submitting a preventive medicine services code (99381-99397) for the routine exam and the appropriate office visit code (99201-99215) with modifier -25, “Significant, separately identifiable [E/M] ...

Level 2 Office Consult: 99242 CPT Code

Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family.

What CPT code replaced 99242?

There are no replacement codes. You must determine the patient type, new, established or inpatient, and then use the 95 or 97 guidelines to determine the level of service. 99201-99215 or 99221-99223. If the payer has adopted Medicare policy then you cannot bill consult codes.

If a doctor is asked to come in and "consult" and it fits the rules for billing a true consult, then yes you would bill a 99221-99223. However, if the doctor is "consulting" on a problem they will be managing or currently manage then you should bill a 99231-99233.

Most pre-op exams will be coded with Z01. 818. The ICD-10 instructions say to use the preprocedural diagnosis code first, and then the reason for the surgery and any additional findings.

When the surgeon sees the patient the day of surgery prior to the operation that visit is not billable. This is because the preoperative time of that visit has already been valued in the 90-day global code (CPT 27447) as part of the pre-time package.

Are consultation codes obsolete? In 2010 the Centers for Medicare and Medicaid Services stopped paying for consultation codes.