CPT E/M Consultation Code Differences

The two sets of E/M (evaluation and management) consultation codes in CPT (Current Procedural Terminology) coding are 99241-99245 for outpatient consultations and 99251-99255 for inpatient consultations (American Medical Association, 2019). There are several key differences between these two sets of codes. One key difference is the setting in which the consultation takes place. Outpatient consultations occur in a clinic or other outpatient setting, while inpatient consultations take place in a hospital or other inpatient setting. Another difference is the level of complexity and intensity of the consultation. Outpatient consultations are generally less complex and intense than inpatient consultations, and the codes reflect this difference. For example, the highest level of outpatient consultation (99245) is generally less complex and intense than the lowest level of inpatient consultation (99251). To be coded as a consultation, certain elements must be present. These elements include the reason for the consultation, the evaluation and management of the patient, and the communication of the consultation findings to the patient’s primary care provider (American Medical Association, 2019). Cont…