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Level 5 Hospital Consult (99255)
The 99255 represents the highest level of care for hospital consults. Internist used the 99255 to bill for 22.2% of hospital consults in 2003. To get an idea of the frequency of use of this code among sub-specialists, nephrologists used this level of care for 25.7% of consults performed in the hospital during that same year. The 99255 ranked 79th among the most frequently used CPT codes by all physicians in 2003. Usually the presenting problems are of moderate to high severity. The reimbursement for this level of care is approximately $192.10.
The documentation for this encounter requires THREE out of THREE of the following :
1) Comprehensive History
2) Comprehensive Exam
3) High Complexity Medical Decision-Making
Or 110 minutes spent face-to-face
with the patient if coding based on time. The appropriate
documentation must be included.
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