Laureen: Q: Anesthesia Consultation. The question is: Pre-anesthesia consultation (i.e. referral by the surgeon to the anesthesiologist) prior to surgery, can someone explain to me the criteria for code selection 99241, 99242, 99243, 99244 or 99245? Because many times HPI will have few elements only when Medical decision making will be high.
Medical Coding Anesthesia Consultation – Video
A: Basically, that code range is the consult codes from E/M. Consult codes require 3 of the 3 key components. So if you have a low level history – like this student was asking, the history of present illness is very brief, it’s going to bring down the overall history, which in turn is going to bring down your overall E/M level. That’s true. That’s the way E/M codes work.
So, if you have a relatively healthy patient going for elective surgery, the level of complexity is going to be pretty low so the E/M, the consult code is going to be low because of that. But, if you have an elderly or a more sickly patient going in for a very serious injury then you’re going to see that those 3 key elements are going to be more complex and therefore you will get a higher E/M code. That’s pretty much the way it works for all HEM-based codes (history, exam, medical decision making based codes); basically, the ones that have the bullets next to them in E/M.
What I did is I just grabbed the shot from the E/M manual. I don’t normally use these boxes too much. For me, I don’t like the way it’s laid out. I guess, I just kind of trained myself a different way, but I thought for this discussion it was kind of helpful.
So, you can see the five levels of consult codes: 99241 to 99245. The higher you go up, the higher RVU, the higher dollar amount it pays out. So, a lot of people think, “Oh, consult, lots of money, high level.” But that’s not always the case like this student was experiencing with a low level of HPI. So, here, it’s talking about history and exam elements and then the bottom is medical decision making.
If you have a problem- focused history, which would correspond with the low level of HPI, the highest you can get is a 99241, because this is the 3-of-3 situation. You have to have all 3 elements met. So, if it’s a problem-focused even if you have medical decision making that’s high because you have to meet all 3, for a 99245 you need to have a comprehensive history and a comprehensive exam. We don’t have that if it’s problem-focused, so we can’t code a level 5. Can we code, if we have moderate medical decision making? No. If you still have a problem-focused history, it’s going to pull it down to a 241. So, that’s how it works with these key components when it’s 3 of 3, which consults are.
Now, if it happened to be another type of E/M like an established office patient then those are 2 of 3, in that case you can drop whatever the lowest one is. Fortunately, whichever way you look at it, with consults you have to meet or exceed all three of the bullets as described in E/M.
More Information about Medical Coding Anesthesia
Video – Anesthesia Coding
AAPC – Anesthesia CPT Codes