The Admission Consult

Code of the Month

ADMISSION CONSULTS

99251: Inpatient consultation, which requires these three key components:

• A problem-focused history;
• A problem-focused examination; and
• Straightforward medical decision-making.

Counseling and/or coordination of care with other providers 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 self-limiting or minor. Physicians typically spend 20 minutes at the bedside and on the patient’s hospital floor or unit.

99252: Inpatient consultation, which requires these three key components:

• An expanded problem-focused history;
• An expanded problem-focused examination; and
• Straightforward medical decision-making.

Counseling and/or coordination of care with other providers 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. Physicians typically spend 40 minutes at the bedside and on the patient’s hospital floor or unit.

99253: Inpatient consultation, which requires these three key components:

• A detailed history;
• A detailed examination; and
• Medical decision-making of low complexity.

Counseling and/or coordination of care with other providers 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 severity. Physicians typically spend 55 minutes at the bedside and on the patient’s hospital floor or unit.

99254: Inpatient consultation, requires three key components:

• A comprehensive history;
• A comprehensive examination; and
• Medical decision-making of moderate complexity.

Counseling and/or coordination of care with other providers 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. Physicians typically spend 80 minutes at the bedside and on the patient’s hospital floor or unit.

99255: Inpatient consultation, which requires these three key components:

• A comprehensive history;
• A comprehensive examination; and
• Medical decision-making of high complexity.

Counseling and/or coordination of care with other providers 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. Physicians typically spend 110 minutes at the bedside and on the patient’s hospital floor or unit.

These codes are used for new or established patients (those who have received face-to-face services from a physician or someone from the physician’s group within the past three years). The physician does not have to spend the associated “typical” visit time with the patient in order to report an initial hospital care code. Time is only considered when more than 50% of the total visit time is spent counseling/coordinating pat­ient care. See Section 30.6.1C, www.cms.hhs.gov/manuals/downloads/clm104c12.pdf for more information about reporting visit level based on time.