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Level 1 Hospital Consult (99251)

This is the lowest level of care for a hospital consult.  Nephrologists use this code for only 1% of these encounters.  Usually the presenting problems are self-limited or minor.  The reimbursement for this level of care is approximately $51. You probably should not even THINK of using this code more than once a year because the acuity of care is so feeble. Medicare doesn't pay for consults any more (view the web-course below for details).

Documentation requires THREE out of THREE of the following :

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

Or 35 minutes spent face-to-face with the patient if coding based on time.  The appropriate documentation must be included.

Click HERE for a 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


Basic Course Preview
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.    
  For mutliple users, consider an E/M Compliance Web Portal.


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