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Level 3 Office Consult (99243)

This is the second most commonly used code used to bill for consults in the office.  Internists selected the 99243 for 29.8% of these encounters in 2003.  To get an idea of the frequency of use of this code among sub-specialists, nephrologists used this level of care for 15.9% of consults performed in the office during that same year (which added up to 25,238 visits). The 99243 ranked 53rd among the most frequently used CPT codes among all physicians in 2003.  The reimbursement for this level of care is approximately $119.00.  Usually the presenting problems are of moderate severity. 

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 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


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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