In a skilled nursing facility, a 91-year-old male requires an inpatient follow-up consultation. The physician performs a comprehensive history and examination totaling about 90 minutes. Which evaluation and management code is appropriate?

In a skilled nursing facility, a 91-year-old male requires an inpatient follow-up consultation. The physician performs a comprehensive history and examination totaling about 90 minutes. Which evaluation and management code is appropriate?

• A. 99254
• B. 99253
• C. 99255
• D. 99251

Answer: (A)

Inpatient consult codes are chosen from the combination of history, examination, and medical decision making, not merely by how long the encounter lasts. A 91-year-old in a skilled nursing facility who receives a comprehensive history and a comprehensive exam points to a level 4 inpatient consultation, which CPT describes as a comprehensive history and examination with moderate medical decision making. The 90-minute duration reflects thorough evaluation, but without explicit evidence of high-complexity MDM (extensive data review, risk, and management options), it fits the moderate MDM level rather than the highest level. Therefore, the appropriate code is the level 4 inpatient consult. Lower levels (problem-focused or expanded problem-focused) don’t meet the comprehensive history/exam criterion, and the highest level would require high complexity MDM not stated in the scenario.

Inpatient consult codes are chosen from the combination of history, examination, and medical decision making, not merely by how long the encounter lasts. A 91-year-old in a skilled nursing facility who receives a comprehensive history and a comprehensive exam points to a level 4 inpatient consultation, which CPT describes as a comprehensive history and examination with moderate medical decision making. The 90-minute duration reflects thorough evaluation, but without explicit evidence of high-complexity MDM (extensive data review, risk, and management options), it fits the moderate MDM level rather than the highest level. Therefore, the appropriate code is the level 4 inpatient consult. Lower levels (problem-focused or expanded problem-focused) don’t meet the comprehensive history/exam criterion, and the highest level would require high complexity MDM not stated in the scenario.