Review about CPT 99244 AND 99245

Office Consultation Codes 99244 and 99245

As a Medicare Contractor, Highmark Medicare Services performs reviews of claims to ensure the services being reported to Medicare are reasonable and necessary and coded correctly.   The Medical Review Department at Highmark Medicare Services recently conducted widespread post payment audits of Maryland providers billing procedure codes 99244 and 99245.

The findings of this review revealed the following:

•  52% of office consultations, procedure code 99244, were billed incorrectly;
•  86% of office consultations, procedure code 99245, were billed incorrectly.  

In the office or other outpatient setting, the consulting physician or qualified NPP should use the appropriate office or outpatient consultation codes (99241-99245) for initial consultation services.   Consultations require all three key components (history, exam, and medical decision making) to be met or exceeded which is important when determining the level of service supported by the medical documentation. 

While, the number one error for both procedure codes was incorrectly coding the level of service, other issues were identified.  The issues included missing consultation requests, no reports communicated back to the referring provider, and no documentation to support the billed service.   Incorrect coding errors most frequently occur due to over-coding situations: i.e., the service was billed at a higher level than what was substantiated through the documentation submitted.