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Tag Archives: examples

Multiple Endoscopy Rule Examples

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In my last blog “Special Rules Apply to Endoscopic Sinus Surgeries,” I discussed the change to the Multiple Endoscopy Rule for multiple surgeries when performed within the family of endoscopic sinus codes. How Does the Multiple Endoscopy Rule Affect Payment? Using the multiple endoscopy rule with the base code 31231 Nasal endoscopy, diagnostic, unilateral or […]

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Clinical Examples

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The clinical examples that are provided in this supplement are limited to Office or Other Outpatient Services, Hospital Inpatient Services, Consultation and Critical Care services. These clinical examples do not encompass the entire scope of medical practice. Inclusion or exclusion of any particular specialty group does not infer any judgment of importance or lack thereof; nor does it limit the applicability of the example to any particular specialty.

Office / Outpatient Services

New patient

99201 Clinical Examples
99202 Clinical Examples
99203 Clinical Examples
99204 Clinical Examples
99205 Clinical Examples

Established patient

99211 Clinical Examples
99212 Clinical Examples
99213 Clinical Examples
99214 Clinical Examples
99215 Clinical Examples

Consults

99241 Clinical Examples
99242 Clinical Examples
99243 Clinical Examples
99244 Clinical Examples
99245 Clinical Examples

Hospital Inpatient Services

Initial Hospital Care

99221 Clinical Examples
99222 Clinical Examples
99223 Clinical Examples

Subsequent Hospital Care

99231 Clinical Examples
99232 Clinical Examples
99233 Clinical Examples

Consults

99251 Clinical Examples
99252 Clinical Examples
99253 Clinical Examples
99254 Clinical Examples
99255 Clinical Examples


Emergency Department Services

New or Established patient 


Critical Care Services



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Clinical Examples for 99251

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Initial hospital consultation for a 27-year-old female with fractured incisor post-intubation. (Oral & Maxillofacial Surgery)

Initial hospital consultation for an orthopaedic patient on IV antibiotics who has developed an apparent candida infection of the oral cavity .(Oral & Maxillofacial Surgery)

Initial inpatient consultation for a 30-year-old female complaining of vaginal itching, post orthopaedic surgery. (Obstetrics & Gynecology)

Initial inpatient consultation for a 36-year-old male on orthopaedic service with complaint of localized dental pain. (Oral & Maxillofacial Surgery)


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Clinical Examples for 99252

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Initial hospital consultation for a 45-year-old male, previously abstinent alcoholic, who relapsed and was admitted for management of gastritis, The patient readily accepts the need for further treatment. (Addiction Medicine)

Initial hospital consultation for a 35-year-old dialysis patient with episodic oral ulcerations. (Oral & Maxillofacial Surgery)

Initial preoperative consultation for a 43-year-old women with cholecystitis and well-controlled hypertension. (Cardiology)

Initial inpatient consultation for recommendation of antibiotic prophylaxis for a patient with a synthetic heart valve who will undergo urologic surgery. (Internal Medicine)

Initial inpatient consultation for possible drug induced skin eruption in 50-year-old male. (Dermatology)

Preoperative inpatient consultation for evaluation of hypertension in a60-year-old male will undergo a cholecystectomy. Patient had a normal annual check-up in your office four months ago. (Internal Medicine)

Initial inpatient consultation for 66-year-old patient with wrist and hand pain and finger numbness, secondary to carpal tunnel syndrome.(Orthopaedic Surgery/Plastic Surgery)

Initial inpatient consultation for a 66-year-old male smoker referred for pain management immediately status post-biliary tract surgery done via sub-costal incision. (Anesthesiology/Pain Medicine)    


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Clinical Examples for 99253

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Initial hospital consultation for 50-year-old female with incapacitating knee pain due to generalized rheumatoid arthritis. (Orthopeadic Surgery)

Initial hospital consultation for a 60-year-old male with avascular  necrosis of the left femoral heel with increasing pain. (Orthopaedic Surgery)

Initial hospital consultation for a 45-year-old female with compound mandibular fracture and concurrent head, abdominal, and/or orthopaedic injuries. (Oral & Maxillofacial)

Initial hospital consultation for a 22-year-old female, paraplegic, to evaluation wrist and hand pain. (Orthopaedic Surgery)

Initial hospital consultation for a 40-year-old male with 10-day history of incapacitating unilateral sciatica, unable to walk now, not improved by bed rest. (Neurosurgery)

Initial hospital consultation, requested by pediatrician, for treatment recommendations for a patient admitted with persistent inability to walk following soft tissue injury to ankle. (Physiatry)

Initial hospital consultation for a 27-year-old previously healthy male who vomited during IV sedation and may have aspirated gastric contents. (Anesthesiology)

Initial hospital consultation for a 33-year-old female, post-abdominal surgery, who now has a fever. (Internal Medicine)

Initial inpatient consultation for a 57-year-old male, post lower endoscopy, for evaluation of abdominal pain and fever. (General Surgery)

Initial inpatient consultation for rehabilitation of a 73-year-old female one week after management of a hip fracture. (Physical Medicine & Rehabilitation)

Initial inpatient consultation for diagnosis/management of fever following abdominal surgery. (Internal Medicine)

Initial inpatient consultation for a 35-year-old female with a fever and pulmonary infiltrate following cesarean section. (Pulmonary Medicine)

Initial inpatient consultation for a 42-year-old non-diabetic patient, postoperative cholecystectomy, now with an acute urinary tract infection. (Nephrology)

Initial inpatient consultation for 53-year-old female with moderate uncomplicated pancreatitis. (Gastroenterology)

Initial inpatient consultation for 45-year-old patient with chronic neck pain with radicular pain of the left arm. (Orthopaedic Surgery)

Initial inpatient consultation for 8-year-old patient with new onset of seizures who has a normal examination and previous history. (Neurology)


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Clinical Examples for 99254

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Initial in patient consultation for a 15-year-old patient with painless swelling of proximal humerus with lytic lesion by X-ray. (Orthopaedic Surgery)

Initial hospital consultation for evaluation of a 29-year-old female with a diffusely positive medical review of systems and history of multiple surgeries. (Psychiatry)

Initial hospital consultation for a 70-year-old diabetic female with gangrene of the foot. (Orthopaedic Surgery)

Initial inpatient consultation for a 47-year-old female with progressive pulmonary infiltrate, hypoxemia, and diminished urine output. (Anesthesiology)

Initial hospital consultation for a 13-month-old with spasmodic cough, respiratory distress, and fever. (Allergy & Immunology)

Initial consultation for a patient with failed total hip replacement with loosening and pain upon walking. (Orthopaedic Surgery)

Initial hospital consultation for a 62-year-old female with metastatic breast cancer to the femoral neck and thoracic vertebra. (Orthopaedic Surgery)

Initial hospital consultation for a 39-year-old female with nephrolithiasis requiring extensive opioid analgesics, whose vital signs are now elevated, She initially denied any drug use but today gives history of multiple substance abuse, including opioids and prior treatment for a personality disorder. (Psychiatry)

Initial hospital consultation for a 70-year-old female without previous psychiatric history, who is now experiencing nocturnal confusion and visual halluncinations following hip replacement surgery. (Psychiatry)

Initial inpatient consultation for evaluation of a 63-year-old in the ICU with diabetes and chronic renal failure who develops acute respiratory distress syndrome 36 hours after a mitral value replacement. (Anesthesiology)

Initial inpatient consultation for a 66-year-old female with enlarged supraclavicular lymph nodes, found on biopsy to be malignant. (Hematology/Oncology)

Initial inpatient consultation for a 43-year-old female for evaluation of sudden painful visual loss, optic neuritis, and episodic paresthesia. (Ophthalmology)

Initial inpatient consultation for evaluation of a 71-year-old male with hyponatremia (serum sodium 114) who was admitted to the hospital with pneumonia. (Nephrology)

Initial inpatient consultation for a 72-year-old male with emergency admission for possible bowel obstruction. (Internal Medicine/General Surgery)

Initial inpatient consultation for a 35-year-old female with fever, swollen joints, and rash of one-week duration. (Rheumatology)


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Clinical Examples for 99291

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First hour of critical care of a 65-year-old man with septic shock following relief of ureteral obstruction caused by a stone.

First hour of critical care a 15-year-old with acute respiratory failure from asthma

First hour of critical of a 45-year-old who sustained a liver laceration, cerebral hematoma, flailed chest, and pulmonary contusion after being struck by an automobile.

First hour of critical care of a 65-year-old women who, following a hysterectomy, suffered a cardiac arrest associated with a pulmonary embolus.

First hour of critical care of a 6-month-old with hypovolemic shock secondary to diarrhea and dehydration

First hour critical of a 3-year-old with respiratory failure secondary to pneumocystis carinii pneumonia


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Clinical Examples for 99282

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Emergency department visit for a 20-year-old student who presents with a painful sunburn with blister formation on the back.  

Emergency department visit for a child presenting with impetigo localized to the face.  

Emergency department visit for a patient with a minor traumatic injury of an extremity with localized pain, swelling, and bruising.  

Emergency department visit for an otherwise healthy patient whose chief complaint is red, swollen cystic lesion on his/her back.  

Emergency department visit for a patient presenting with a rash on both legs after exposure to poison ivy. 

Emergency department visit for a young adult patient with infected sclera and purulent discharge from both eyes without pain, visual disturbance, or history of foreign body in either eye.  


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Clinical Examples for 99283

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Emergency department visit for a sexually active female complaining of vaginal discharge who is afebrile and denies experiencing abdominal or back pain.  

Emergency department visit for a well-appearing 8-year-old who has a fever, diarrhea, and abdominal cramps; is tolerating oral fluids and is not vomiting. 

Emergency department visit for a patient with an inversion ankle injury, who is unable to bear weight on the injured foot and ankle. 

Emergency department visit for a patient who has a complaint of acute pain associated with a suspected foreign body in the painful eye.  

Emergency department visit for a healthy for a healthy, young adult patient who sustained a blunt head injury with local swelling and bruising without subsequent confusion, loss of consciousness, or memory deficit. 


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