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Level 3 Hospital Consult (99253)

This is the third highest level of care for hospital consults.  Internists used this code for 26.8% of these encounters in 2003.  To get an idea of the frequency of use of this code among sub-specialists, nephrologists used the 99253 somewhat less often, choosing it for 21.3% of consults performed in the hospital during that same year.  This code ranked 64th among the most frequently used CPT codes by all physicians in 2003.  Usually the presenting problems are of moderate severity.  The reimbursement for this level of care is approximately $97.20.

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

1)  Detailed History
2)  Detailed Exam
3)  Low Complexity Medical Decision-Making

Or 55 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.    
  For mutliple users, consider an E/M Comliance Web Portal.


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