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Level 2 Office Consult (99242)

This is the second lowest level of care for office consultations.   Internists used this code for 8.6% of these encounters.  To get an idea of the frequency of use of this code among sub-specialists, nephrologists used the 99242 for only 2.5% of consults performed in the office during that same year (which added up to only 3,959 visits in the entire country).  The 99242 ranked 125th among the most frequently used CPT codes in 2003 among all physicians combined.  Usually the presenting problems are of low severity.  The reimbursement for this level of care is approximately $90.00.  

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 30 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


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.    
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