'Click to return to E/M University Home page, EM Coding Education


Level 4 Hospital Consult (99254)

This is the most popular code used to bill for hospital consults.  Internists selected the 99254 code for 41% 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 48% of consults performed in the hospital during that same year. The 99254 ranked 44th among the most frequently used CPT codes by all physicians in 2003.  Usually the presenting problems are of moderate to high severityThe reimbursement for this level of care is approximately $139.70. 

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

1)   Comprehensive History
2)   Comprehensive Exam
3)   Moderate Complexity Medical Decision-Making

Or 80 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.


Home   |   Contact Us   |   Privacy Policy
Copyright © 2003 -  EM University. Web Design: Abacus Web Services
Click to return to E/M University Home page, EM Coding Education