Hospital Consults (99251-99255)

As of January 1, 2010, MEDICARE no longer pays inpatient (or outpatient) consults.

To view a 3-minute video on how hospital consults should now be coded, click HERE

To download our CONSULT ALGORITHM and fact sheet in PDF format, click HERE

These codes are used to report hospital consults for new or established patients.  Internists performed a total of 1,576,466 of these services in 2003.  A consult is provided by a physician whose opinion or advice is requested by another physician about a specific clinical problem or issue.  Consultations may also be requested by nurse practitioners or physician assistants.  The name of the requesting clinician and the reason for the consultation must be recorded in the documentation.  The results and recommendations of the consult must be sent to the requesting physician.  In the hospital, documentation of the consult on the patient’s chart satisfies this requirement.  Do not use these codes to report a consult initiated by a patient or a family member.  (These services are reported using the separate codes for confirmatory consultations.)  If the consulting physician assumes partial care of the patient after the initial consultation, those additional services are reported as hospital progress notes--NOT as follow-up consultation services.  There are five levels of care for this type of encounter which all require the qualifying documentation of three out of three key components.