HOSPITAL DISCHARGE SERVICES

99238—Time: 30 minutes or less 

99239—Time: More than 30 minutes

Consultations

Medicare no longer pays for the consultation codes. When coding for Medicare or for commercial carriers that have followed Medicare’s lead, 90801 may be used for both inpatient and outpatient consults. Psychiatrists who choose to use E/M codes to report outpatient consults should use the outpatient new patient codes (99201–99205). For inpatient consults, the codes to use are hospital inpatient services, initial hospital care for new or established patients (99221– 99223). For consults in nursing homes, initial nursing facility care codes should be used (99304–99306); if the consult is of low complexity, the subsequent nursing facility codes may be used (99307–99310). As with all E/M codes, the selection of the specific code is based on the complexity of the case and the amount of work required. Medicare has created a new modifier, A1, to denote the admitting physician so that more than one physician may use the initial hospital care codes.

OFFICE OR OTHER OUTPATIENT CONSULTATIONS 

99241—The three following components are required: 

• Problem-focused history

• Problem-focused examination 

• Medical decision making that is straightforward 

Presenting problem(s): Self-limited or minor 

Typical time: 15 minutes face-to-face with patient and/or family

 99242—The three following components are required: 

• Expanded problem-focused history 

• Expanded problem-focused examination 

• Medical decision making that is straightforward 

Presenting problem(s): Low severity 

Typical time: 30 minutes face-to-face with patient and/or family

 99243—The three following components are required:

 • Detailed history 

• Detailed examination 

 • Medical decision making of low complexity 

Presenting problem(s): Moderate severity 

Typical time: 40 minutes face-to-face with patient and/or family 

99244—The three following components are required: 

• Comprehensive history 

• Comprehensive examination 

• Medical decision making of moderate complexity 

Presenting problem(s): Moderate to high severity 

Typical time: 60 minutes face-to-face with patient and/or family 

99245—The three following components are required: 

• Comprehensive history 

• Comprehensive examination 

• Medical decision making of high complexity 

Presenting problem(s): Moderate to high severity

Typical time: 80 minutes face-to-face with patient and/or family