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Infectious Disease

DIXIE Posted Thu 17th of July, 2014 12:35:29 PM

Proper code to use - Medicaid patient - called in for consultation
by admitting physician what would the inital visit be coded as?

SuperCoder Answered Thu 17th of July, 2014 18:01:45 PM

Based on your question, I am assuming that the patient status is inpatient in the hospital setting. If this is the case, the appropriate code series to use are the inpatient consultation codes 99251-99255. Although Medicare does not recognize consultation codes, Medicaid and other Non-Medicare payers recognize consultation codes.

99251-Inpatient consultation for a new or established patient, which requires these 3 key components:
A problem focused history;
A problem focused examination; and
Straightforward medical decision making.

99252-Inpatient consultation for a new or established patient, which requires these 3 key components:
An expanded problem focused history;
An expanded problem focused examination; and
Straightforward medical decision making.

99253-Inpatient consultation for a new or established patient, which requires these 3 key components:
A detailed history;
A detailed examination; and
Medical decision making of low complexity.

99254-Inpatient consultation for a new or established patient, which requires these 3 key components:
A comprehensive history;
A comprehensive examination; and
Medical decision making of moderate complexity.

99255-Inpatient consultation for a new or established patient, which requires these 3 key components:
A comprehensive history;
A comprehensive examination; and
Medical decision making of high complexity.

Thanks for your question.

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