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LEVEL 2 HOSPITAL CONSULT
 

 

Level 2 Hospital Consult (99252)

This is the second lowest level of care for hospital consultations.   Nephrologists use the 99252 for only 2% of consults performed in the hospital.  Dr. Jensen (who is a nephrologist) has used this code "maybe once or twice in ten years." Usually the presenting problems are of low severity.  The reimbursement for this level of care is approximately $81. You are probably over-utilizing this level of care because you don't realize that literally almost no medical decision-making is required for this visit. As usual, the web-course explains all.

The documentation for this encounter requires THREE out of THREE of the following :

1)   Expanded Problem Focused History
2)   Expanded Problem Focused Exam
3)   Straightforward Medical Decision-Making

Or 40 minutes spent face-to-face with the patient if coding based on time.  The appropriate documentation must be included.

Clinical Example

This topic is covered in more detail in of one of our web-based E/M coding courses.
 

E/M Consult Services

Consult Services   Related Topics
 

 

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Although Medicare no longer pays for consult services, some private payers still do. But beware. Auditors love to downcode these visits when doctors don't include the exact right terminology. Learn to get it right.  
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