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March 12, 2024

Coding for observation services

Cpt codes for observation services.

Beginning January 1, 2023 there are two sets of codes used for both inpatient status and observation level of care. Coding for observation services no longer has a distinct set of CPT® codes, those were deleted. Use 99221–99223 for initial inpatient or observation care services and use 99231–99233 for inpatient or observation subsequent visits. 99238 and 99239 are the discharge codes.

For admission and discharge on the same calendar date, use codes 99234—99236.

Medicare says, “Only the attending physician of record reports the discharge day management service.”

Place of service

Continue to report the correct place of service on the claim form, place of service 21 for inpatient hospital and place of service 22 for on campus—outpatient hospital. Observation is an outpatient service.

Consulting physicians

Following CPT® rules, a consulting physician would report inpatient consult codes 99252—99255 for the initial service. These are now defined as inpatient or observation services.  Use 99231—99233 for follow up visits. For patients with commercial insurance that still recognizes consultation codes, this is the correct coding for observation services.

Coding for observation services for Medicare patients seen in consultation

Medicare stopped recognizing consultation codes in 2010. Chapter 12 of Medicare’s Claims Processing Manual has not changed its instruction with the deletion of observation codes 99218—99220, 99224-99226, and 99217.  Their manual says “Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient’s observation services began. All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes.”

  • For all payers, the admitting physician uses 99221-99223 for patients in observation level of care. Add modifier AI for Medicare.
  • For commercial payers that recognize consults, the consulting physician uses 99252—99255 for patients in observation level of care.
  • For Medicare patients, the consulting physician uses office and/or other outpatient codes 99202—99215. Keep in mind the definition of new patient. A new patient is a patient who has never been seen by that physician or their same specialty partner (in their group) for the past three years. Use these codes for the initial visit and subsequent visits.

CMS citations: Medicare Claims Processing Manual, Ch. 12, Section 30.6. 9 and 30.6.10

Download the E/M guide for more detailed information about coding for observation (and other E/M services).

Coding Guide – E/M Services

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Last revised March 11, 2024 - Betsy Nicoletti Tags: hospital inpatient/observation

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  • October 2022 | Volume 107...
  • For Your Practice

What Surgeons Should Know

2023 changes to reporting inpatient and observation evaluation and management services.

Jan Nagle, MS, and Teri Romano, BSN, MBA, CPC, CMDP

October 1, 2022

In 2021, the Current Procedural Terminology (CPT*) Editorial Panel revised the office/outpatient evaluation and management (E/M) codes (99202–99205, 99211–99215). For CPT 2023, the panel has revised additional families of E/M codes to be consistent with the changes to the office/outpatient E/M codes. This column focuses on the changes to the hospital inpatient and hospital observation E/M codes that surgeons routinely use. 

Will there continue to be separate E/M codes for inpatient and observation care in 2023?

No, for 2023, the codes for reporting observation care services (99217–99220) will be deleted and observation care services will be merged into the codes previously used to report only inpatient care services (99221–99233, 99238–99239). See Table 1 for the revised 2023 code descriptors. Although the same code will be used to report either inpatient or observation care services, you will still need to know the facility status of the patient to accurately report the place of service code as either hospital inpatient (21) or hospital outpatient (22).

Will there continue to be separate codes for initial and subsequent hospital visits?

Yes, codes 99221–99223 will continue to be reported for new patients and codes 99231–99233 will continue to be reported for established patients.

In addition to merging inpatient and observation care services into single codes, how else has this family of codes changed?

Similar to the changes made to the office/outpatient E/M codes, only a “medically appropriate” history and/or examination will be required for reporting inpatient/observation care services. The extent of history and physical examination is not an element in selecting the level of these E/M codes. In addition, references to a “focused, detailed, or comprehensive” history and/or examination have been removed from the code descriptors.

How do I select the correct code?

Code selection will be based on either the level of medical decision-making (MDM) as defined for each service or the total time on the date of the encounter. These elements will be used for selecting all hospital E/M visit codes with the exception of emergency department visit codes (which only use MDM) and critical care services codes (which only use time). 

How is MDM used to select the level of code?

For codes 99221–99223 and 99231–99233, the level (straightforward, low, moderate, high) of MDM selected is based on two of the three elements of MDM: (1) number and complexity of problems addressed at the encounter, (2) amount and/or complexity of data to be reviewed and analyzed, and/or (3) risk of complications and/or morbidity or mortality of patient management. These are exactly the same elements used to select a level of office/outpatient E/M services code.

How do I use total time to select a level of code?

When time is used for reporting inpatient/observation care E/M services codes, the time defined in the code descriptors is used for selecting the appropriate level of services. The time includes both the face-to-face time with the patient and/or family/caregiver and non-face-to-face time personally spent by the physician and/or other qualified healthcare professional (QHP) on the date of the encounter. It includes time regardless of the location of the physician/QHP (for example, whether on or off the inpatient/observation unit). It does not include any time spent in the performance of other separately reported procedures or service(s). For coding purposes, time for these services is the total time on the date of the encounter.

How is time reported if both the physician and QHP provide face-to-face and non-face-to-face services on the day of encounter?

A visit in which a physician and QHP both provide services related to the visit is defined as a split or shared visit. When time is being used to select the appropriate level of services for which time-based reporting of split/shared visits is allowed, the time personally spent by the physician and QHP assessing and managing the patient and/or counseling, educating, communicating results to the patient/family/caregiver on the date of the encounter is summed to define total time. However, remember that only distinct time should be summed for split/shared visits (for example, when two or more individuals jointly meet with or discuss the patient, only the time of one individual should be counted).

I have heard there are new restrictions for reporting split/shared visits—is this true?

For Medicare patients in 2022, the Centers for Medicare & Medicaid Services finalized that the treating provider who performs the “substantive portion” of the visit will bill the service. For more information on 2022 reporting, see the April 2022 issue of the Bulletin. For 2023, based on negative comments about the plan that CMS created for 2022, along with changes to the code descriptors, the reporting requirements for a split/shared visit are under review. Look for an update after the final rule for the 2023 physician fee schedule is released in November.

What resources does the ACS offer to improve my coding skills?

The ACS collaborates with KarenZupko & Associates (KZA) to offer coding courses that provide the tools necessary to increase revenue and decrease compliance risk. These courses are an opportunity to sharpen your coding skills. You also will be provided online access to the KZA alumni site, where you will find additional resources and frequently asked questions about correct coding. Additional information about the courses and registration can be accessed at karenzupko.com/general-surgery .

* All specific references to CPT codes and descriptions are © 2022 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.

Jan Nagle is an independent consultant in Chicago, IL, who assists with AMA CPT coding education and health data analyses.

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Simplified guidelines for coding and documenting evaluation and management office visits are coming next year. Learn how to apply the guidelines to some common visit types.

CAROL SELF, CPPM, CPC, EMT, KENT MOORE, AND SAMUEL L. CHURCH, MD, MPH, CPC, FAAFP

Fam Pract Manag. 2020;27(6):6-11

Author disclosures: no relevant financial affiliations disclosed.

Editor's note: In its 2021 Medicare Physician Fee Schedule, CMS released new guidance regarding coding for prolonged E/M services. This article has been updated accordingly.

cpt code for initial outpatient hospital visit

The American Medical Association (AMA) has established new coding and documentation guidelines for office visit/outpatient evaluation and management (E/M) services, effective Jan. 1, 2021. The changes are designed to simplify code selection and allow physicians to spend less time documenting and more time caring for patients. Physicians and other qualified health professionals (QHPs) will be able to select the level of office visit using either medical decision making (MDM) alone or total time (excluding staff time) on the date of service. In addition, the history and physical exam will be eliminated as components of code selection, and code 99201 will be deleted (code 99211 will not change). (See “ E/M coding changes summary .”)

To follow up on the previous FPM article detailing these changes (see “ Countdown to the E/M Coding Changes ,” FPM , September/October 2020), we have applied the 2021 guidelines to some common types of family medicine visits, and we explain below how documentation using a typical SOAP (Subjective, Objective, Assessment, and Plan) note can support the chosen level of service.

In each vignette, we've arrived at a code based only on the documentation included in the note. It's possible that a more extensive note could support a higher level of service by further clarifying the physician's decision making. But we've analyzed each case through an auditor's lens and tried not to make any assumptions that aren't explicitly supported by the note.

Starting in January, physicians and other qualified health professionals will be able to select the level of office visit using either medical decision making alone or total time (excluding staff time) on the date of service.

Medical decision making is made up of three factors: problems addressed, data reviewed, and the patient's risk. The highest level reached by at least two out of three determines the overall level of the office visit.

If the visit was time-consuming, but the medical decision making did not rise to a high level, the physician or qualified health professional may want to code based on total time instead.

MEDICAL DECISION MAKING (MDM)

Starting in January, physicians will be able to select the level of visit using only medical decision making, with a revised MDM table. (See the table at https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf .)

The four levels of MDM (straightforward, low, moderate, and high) will be maintained but will no longer be based on checkboxes or bullet points. The level of service will be determined by the number and complexity of problems addressed at the encounter, the amount and complexity of data reviewed and analyzed, and the patient's risk of complications and morbidity or mortality.

Here's what that looks like in practice:

STRAIGHTFORWARD MDM VIGNETTE

An established patient presents for evaluation of eye matting. The documentation is as follows:

Subjective: 16 y/o female presents with a 2-day history of bilateral eye irritation. She denies any fever or sick contacts. She started having a slight runny nose and cough this morning. She thinks the matting is a little better than yesterday. She wears daily disposable contacts but hasn't used them since her eyes have been bothering her. Her younger sibling has had similar symptoms for a few days.

Objective: Temperature 98.8, BP 105/60, P 58.

General: No distress. Does not appear ill.

HEENT: Mild bilateral conjunctival erythema without discharge. No tenderness over eye sockets. EOMI, PERRL.

Neck: No cervical lymph nodes palpated.

Lungs: Clear to auscultation.

Assessment: Viral conjunctivitis.

Plan: Reviewed likely viral nature of symptoms. Supportive and conservative treatment options reviewed, including eye cleaning instructions and contact lens precautions. Call the office if symptoms persist or worsen. Avoid use of contacts until symptoms resolve.

CPT code: 99212.

Explanation: Under the 2021 guidelines, straightforward MDM involves at least two of the following:

Minimal number and complexity of problems addressed at the encounter,

Minimal (in amount and complexity) or no data to be reviewed and analyzed,

Minimal risk of morbidity from additional diagnostic testing or treatment.

This is the lowest level of MDM and the lowest level of service physicians are likely to report if they evaluate the patient themselves (code 99211 will still be available for visits of established patients that may not require the presence of a physician).

In this fairly common scenario, the assessment and plan make it clear that the physician addressed a single, self-limited problem (“minimal” in number and complexity, per the 2021 MDM guidelines) for which no additional data was needed or ordered, and which involved minimal risk of morbidity.

Per the 2021 CPT guidelines, “For the purposes of medical decision making, level of risk is based upon consequences of the problem(s) addressed at the encounter when appropriately treated.” In this case, there is little risk of morbidity to this patient from the viral infection diagnosed by the physician.

It's possible the physician considered prescribing an antibiotic in this case, but decided against it. Options considered but not selected can be used as an element for “risk of complications,” but they should be appropriate and documented. There is no documentation in this note to indicate the physician made that decision. The documentation provided, therefore, does not support a higher level of service using MDM. But if the physician did make that decision and the ensuing conversation with the patient was time-consuming, the physician always retains the option to choose the level of service based on time instead.

LOW LEVEL OF MDM VIGNETTE

An established patient presents for follow-up for stable fatty liver. The documentation is as follows:

Subjective: 62 y/o female presents for follow-up of nonalcoholic fatty liver. She has no other complaints today and no other chronic conditions. She denies any fever, weight gain, swelling, or skin color changes. She also denies any confusion. She continues to work at her regular job and reports no difficulties there. She denies any unusual bleeding or bruising. Energy is good. Diagnosis was made three years ago, incidentally, on an ultrasound. Condition has been stable since the initial full evaluation.

Objective: BP 124/70, P 76, Temperature 98.7, BMI 26.

General: Well-appearing. Alert and oriented x 3.

Eyes: Sclera nonicteric.

Heart: Regular rate and rhythm; trace pretibial edema.

Abdomen: Soft, nontender, no ascites, liver margin not palpable.

Skin: No bruising.

Labs reviewed and analyzed: CBC normal, CMP with elevated AST (62 IU/ml) and ALT (50 IU/ml), PT/PTT normal.

Last ultrasound was 3 years ago.

Assessment: Nonalcoholic steatohepatitis, stable.

Plan: LFTs continue to be improved since initial diagnosis and 30-pound intentional weight reduction. Continue monitoring appropriate labs at 6-month intervals. Follow up in 6 months, or sooner if swelling, bruising, or confusion. Avoid alcohol. Continue weight maintenance. She is reassured her condition is stable and has no other questions or concerns, especially in light of her prior extensive education on the topic. I am arranging for hepatitis A and B vaccination. Discussed OTC medications, including vitamin E, and for now will avoid them.

CPT code: 99213

Explanation: Under the 2021 guidelines, low-level MDM involves at least two of the following:

Low number and complexity of problems addressed at the encounter,

Limited amount and/or complexity of data to be reviewed and analyzed,

Low risk of morbidity from additional diagnostic testing or treatment.

In this vignette, the patient has one stable chronic illness, which is an example of an encounter for problems low in number and complexity. The risk of complications from treatment is also low. The “Objective” section indicates review of three lab tests, which qualifies as a moderate amount and/or complexity of data reviewed and analyzed. However, the level of MDM requires meeting two of the three bullets above, so the overall level remains low for this vignette.

MODERATE LEVEL OF MDM VIGNETTE

An established patient with obesity and diabetes presents with new onset right lower quadrant pain. The documentation is as follows:

Subjective: 42 y/o female presents for evaluation of 2 days of abdominal pain. She has a history of Type 2 diabetes, controlled. Pain is moderate, 6/10 currently, and 10/10 at worst. The pain is intermittent. The pain is located in the back and right lower quadrant, mostly. She denies diarrhea or vomiting but does note some nausea. She denies fever. She denies painful or frequent urination. She is sexually active with her spouse. She has had a hysterectomy due to severe dysfunctional bleeding. She has not tried any medication for relief. No position seems to affect her pain. She has not had symptoms like this before. Home glucose checks have been in the 140s fasting. Her last A1C was 6.9% two months ago. Family history: Sister with a history of kidney stones.

Objective: BP 160/95, P 110, BMI 36.1.

General: Appears to be in mild to moderate pain. Frequently repositioning on exam table.

HEENT: Moist oral mucosa.

Abdomen: Mild right-sided tenderness. No focal or rebound tenderness. Normal bowel sounds. No CVA tenderness. No suprapubic tenderness. No guarding.

UA with microscopy: 3 + blood, no LE, 50–100 RBCs, 5–10 WBCs.

CBC, CMP, CT stone study ordered stat.

Assessment: Abdominal pain – suspect renal stone. Also consider cholecystitis, gastroparesis, gastroenteritis, appendicitis, and early small bowel obstruction.

Diabetes, type 2, controlled.

Obesity – this is a risk factor for gall-bladder problems, but still favor renal stone.

Plan: Ketorolac 60 mg given in office for pain relief. Hydrocodone/APAP prescription for pain relief. Discussed at length suspicion of renal stone. Will plan lab work and pain control and await CT stone study. Urine sent to reference lab for microscopy. Drink plenty of fluids. Urine strainer provided. Call the office if worsening or persistent symptoms. Await labs/CT for next steps of treatment plan. Will follow up with her if urology referral is indicated.

CPT code: 99214

Explanation: Under the 2021 guidelines, moderate level MDM involves at least two of the following:

Moderate number and complexity of problems addressed at the encounter,

Moderate amount and/or complexity of data to be reviewed and analyzed,

Moderate risk of morbidity from additional diagnostic testing or treatment.

In this vignette, the patient has one undiagnosed new problem with uncertain prognosis (abdominal pain) and two stable chronic conditions (diabetes and obesity). Either one (the new problem with uncertain prognosis or two stable chronic conditions) meets the definition of a moderate number and complexity of problems under the 2021 MDM guidelines. But they do not meet the threshold of a high number and complexity of problems, even when combined.

The physician reviews or orders a total of four tests, which again exceeds the requirements for a moderate amount and/or complexity of data, but doesn't meet the requirements for the high category.

The prescription drug management is an example of moderate risk of morbidity. One might argue that the risk of morbidity is high because renal failure could result from a major kidney stone obstruction. But even then the overall MDM would still remain moderate, because of the number and complexity of problems addressed and the amount and/or complexity of data involved.

HIGH LEVEL OF MDM VIGNETTE

An established patient with a new lung mass and probable lung cancer presents with a desire to initiate hospice services and forgo curative treatment attempts. The documentation is as follows:

Subjective: 92-year-old male presents for follow-up of hemoptysis, fatigue, and weight loss, along with review of his recent chest CT. He reports moderate mid-back pain, new since last week. Appetite is fair. He denies fever. He continues to have occasional cough with mixed blood in the produced sputum.

Objective: BP 135/80, P 95, Weight down 5 pounds from 2 weeks ago, BMI 18.5, O2 sat 94% on RA.

General: Frail-appearing elderly male. No distress or shortness of breath. Able to speak in full sentences.

HEENT: No palpable lymph nodes.

Lungs: Frequent coughing and diffuse coarse breath sounds.

Heart: Regular rate and rhythm.

Ext: No extremity swelling.

MSK: Moderate tenderness over multiple thoracic vertebrae.

CT shows large right-sided lung mass suspicious for malignancy, along with a moderate left-sided effusion. Lytic lesions seen in T6-8.

Assessment: Lung mass, suspect malignancy with bone metastasis.

Plan: After extensive review of the findings, the patient was informed of the likely poor prognosis of the suspected lung cancer. We reviewed his living will, and he reiterated that he did not desire life-prolonging measures and would prefer to allow the disease to run its natural course. He also declines additional testing for diagnosis/prognosis. A shared decision was made to initiate hospice services. Specifically, we discussed need for oxygen and pain control. He declines pain medications for now, but will let us know. He and his son who was accompanying him voiced agreement and understanding of the plan.

CPT code: 99215

Explanation: Under the 2021 guidelines, high level MDM involves at least two of the following:

High number and complexity of problems addressed at the encounter,

Extensive amount and/or complexity of data to be reviewed and analyzed,

High risk of morbidity from additional diagnostic testing or treatment.

In this vignette, the patient has one acute or chronic illness or injury (suspected lung cancer) that poses a threat to life or bodily function. This is an example of a high complexity problem in the 2021 MDM guidelines. The physician reviewed one test (CT), so the amount and/or complexity of data is minimal. A decision not to resuscitate, or to de-escalate care, because of poor prognosis is an example of high risk of morbidity, and the physician has clearly documented that in the plan portion of the note. Consequently, even though the amount and/or complexity of data is minimal, the overall MDM remains high because of the problem addressed and the risk involved.

Under the new guidelines, total time means all time (face-to-face and non-face-to-face) the physician or other QHP personally spends on the visit on the date of service. Examples include time spent reviewing labs or reports, obtaining or reviewing history, ordering tests and medications, and documenting clinical information in the EHR.

The AMA has also created a new add-on code, 99417, for prolonged services. It can be used when the total time exceeds that of a level 5 visit – 99205 or 99215. (See “ Total time plus prolonged services template .”)

TIME-BASED CODING VIGNETTE

An established patient presents with a three-month history of fatigue, weight loss, and intermittent fever, and new diffuse adenopathy and splenomegaly. The documentation is as follows:

Subjective: 30-year-old healthy male with no significant PMH presents with a three-month history of fatigue, weight loss, and intermittent fever. He travels for work and has been evaluated in several urgent care centers and reassured that he likely had a viral syndrome. Fevers have been as high as 101, but usually around 100.5, typically in the afternoons. Testing for flu and acute mono has been negative. He denies high-risk sexual behavior and IV drug use. He denies any sick contacts. He has not had vomiting or diarrhea. He has not had any pain. He denies cough.

Objective: BP 125/80, P 92, BMI 27.4.

General: Well-nourished male, no distress.

HEENT: No abnormal findings.

Lungs: Clear.

Heart: No murmurs. Regular rate and rhythm.

Abdomen: Soft, non-tender, moderate splenomegaly.

Skin: Multiple petechia noted.

Lymph: Multiple cervical, axillary, and inguinal lymph nodes that are enlarged, mobile, and non-tender.

Assessment: Weight loss, lymphadenopathy, and splenomegaly

Plan: Prior to the visit, I spent 15 minutes reviewing the medical records related to his recent symptoms and various urgent care visits. We reviewed the differential at length to include infectious disease and acute myelodysplastic condition. I have ordered stat blood cultures, TB test, EBV titers, echo, and CBC. The pathologist called to report concerning findings on the CBC for likely acute leukemia. I called the patient to inform him of his results and need for additional testing. I also discussed the patient with oncology and arranged a follow-up visit for tomorrow. I spent a total of 92 minutes with record review, exam, and communication with the patient, communication with other providers, and documentation of this encounter.

CPT Codes: 99215 and 99417 x 3.

Explanation: In this instance, the physician has chosen to code based on time rather than MDM. The physician has documented 92 minutes associated with the visit on the date of service, including time not spent with the patient (e.g., time spent talking with the pathologist and time spent in documentation). According to the 2021 CPT code descriptors, 40–54 minutes of total time spent on the date of the encounter represents a 99215 for an established patient.

The 2021 CPT code set also notes that for services of 55 minutes or longer, you should use the prolonged services code, 99417, which can be reported for each 15 minutes beyond the minimum total time of the primary service (99215). The difference between the 92 minutes spent by the physician and the 40-minute minimum for 99215 is 52 minutes. There are three full 15-minute units of 99417 in those 52 minutes, so the physician may report three units of 99417 in addition to 99215. CPT 2021 instructs you to not report 99417 for any time unit less than 15 minutes, so the seven remaining minutes of prolonged service is unreportable.

Note that if this had been a new patient, the physician would only be able to report two units of 99417 in addition to 99205. Though the elements of MDM do not differ between new and established patients, the total time thresholds do. The range for a level 5 new patient is 60–74 minutes.

FINAL THOUGHTS

CPT does not dictate how physicians document their patient encounters. As illustrated above, a standard SOAP note can be used to support levels of MDM (and thus levels of service) under the 2021 guidelines.

Physicians who want to further solidify their documentation in case of an audit may choose to make the elements of MDM more explicit in their documentation. This could be particularly helpful for documenting the level of risk, which is the least clearly defined part of the MDM table and potentially most problematic because of its inherent subjectivity. Stating the level of risk and giving a rationale when possible allows a physician to articulate in the note the qualifying criteria for the submitted code. For example, going back to our vignette of moderate MDM, the physician could note in the chart, “This condition poses a threat to bodily function if not addressed, due to acute kidney injury for an obstructive stone.”

It is also worth noting that much of the note in each case is for purposes other than documenting the level of service. For instance, with history and physical exam no longer required, the subjective and objective portions of the note are recorded primarily for continuity or quality of care rather than to justify the level of service. This provides some administrative simplification. What's in the note will become more about what is needed for medical care and less about payment justification under the new guidelines. That's a plus for primary care.

We hope these examples are helpful as you prepare to implement the 2021 CPT changes. You can also visit https://www.aafp.org/emcoding for more resources and information.

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COMMENTS

  1. Coding Inpatient and Observation Visits in 2023

    Effective Jan. 1, 2023, hospital observation codes 99217-99220 and 99224-99226 are deleted. These services are merged into the existing hospital inpatient services codes 99221-99223, 99231-99233, and 99238-99239, and the subsection is renamed Inpatient Hospital or Observation Care. As in the Office or Other Outpatient Services subsection, the ...

  2. PDF Observation Services

    Initial Observation Care (CPT code range 99218-99220) When a patient receives observation care for less than 8 hours on the same calendar date, the Initial Observation Care, from CPT code range 99218 - 99220, shall be reported by the physician. When a patient is admitted for observation care and then is discharged on a different calendar date ...

  3. Consultation Codes Update

    Finally. And, with it, there is a consultation codes update for 2023. First, CMS stopped recognizing consult codes in 2010. Outpatient consultations (99241—99245) and inpatient consultations (99251—99255) were still active CPT ® codes, and depending on where you are in the country, are recognized by a payer two, or many payers. In 2023 ...

  4. PDF Coding for hospital admission, consultations, and emergency department

    2013 totAL iNitiAL HosPitAL AND outPAtieNt CoNsuLtAtioN FACiLity AND NoNFACiLity rvus 2013 totLA FACiLity rvus 2013 totAL NoNFACiLity rvus Cpt initial hospital care Cpt ed visit Cpt outpatient consultation 99221 2.84 99281 0.60 99241 1.37 99282 1.18 99242 2.58 99222 3.87 99283 1.76 99243 3.52 99284 3.36 99244 5.20 99223 5.30 99285 4.93 99245 6. ...

  5. Evaluation and Management (E/M) Code Changes 2023

    The E/M codes for home care services now include any patient residence, including assisted living facilities, which prior to 2023 had a separate code category (99324-99328, 99334-99337). Now all home or residence services are reported using codes 99341-99345 for new patients and 99347-99350 for established patients.

  6. PDF CPT® Evaluation and Management (E/M) Code and Guideline Changes

    CPT Coding Guidelines, Introduction, Instructions for Use of the CPT Codebook Initial and Subsequent Services Some categories apply to both new and established patients (eg, hospital inpatient or observation care). These categories differentiate services by whether the service is the initial service or a subsequent service.

  7. Office/Outpatient E/M Codes

    More details about these office/outpatient E/M changes can be found at CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99XXX) Code and Guideline Changes. Download the Office E/M Coding Changes Guide (PDF) 2021 E/M Office/Outpatient Visit CPT Codes.

  8. What Is Outpatient Facility Coding and Reimbursement?

    Outpatient facility coding is the assignment of ICD-10-CM, CPT ®, and HCPCS Level II codes to outpatient facility procedures or services for billing and tracking purposes. Examples of outpatient settings include outpatient hospital clinics, emergency departments (EDs), ambulatory surgery centers (ASCs), and outpatient diagnostic and testing ...

  9. E/M coding for outpatient services

    Note: The article below was posted in 2020 and applies to coding for 2020 dates of service. For information about coding office and other outpatient E/M services in 2021, Please see 99202-99215: Office/Outpatient E/M Coding in 2021.. Evaluation and management (E/M) coding is a high-volume area of CPT ® medical coding, meaning that healthcare providers report E/M codes often on medical claims.

  10. How to Code for Observation Services

    The correct codes for these services are 99219 (Thursday), 99214 (Friday) and 99217 (Saturday). You perform a level-II initial observation late Monday afternoon and admit the patient to the ...

  11. A Step-by-Step Time-Saving Approach to Coding Office Visits

    Think time first. If your total time spent on a visit appropriately credits you for level 3, 4, or 5 work, then document that time, code the visit, and be done with it. But if it does not, go to ...

  12. PDF Introduction to 2021 Office and Other Outpatient E/M Codes

    at the visit • This includes the possible management options selected and those considered, but not selected, after shared medical decision making. • CPT examples: • A psychiatric patient with a sufficient degree of support in the outpatient setting • The decision to not hospitalize a patient with advanced dementia with an acute ...

  13. Coding Hospital Admissions From Other Sites of Service

    In this case, you would code an office visit (99201-99215) for services provided on the first day and an initial hospital care code (99221-99223) for services provided on the second day.

  14. The 2023 Hospital and Nursing Home E/M Visit Coding Changes

    Initial nursing home visits are coded with 99304-99306. CPT is deleting the code for nursing home annual exams (99318), which will instead be coded as subsequent nursing home visits (99307-99310 ...

  15. Coding for observation services

    Use 99221-99223 for initial inpatient or observation care services and use 99231-99233 for inpatient or observation subsequent visits. 99238 and 99239 are the discharge codes. For admission and discharge on the same calendar date, use codes 99234—99236. Medicare says, "Only the attending physician of record reports the discharge day ...

  16. What Surgeons Should Know

    2023 Changes to Reporting Inpatient and Observation Evaluation and Management Services. In 2021, the Current Procedural Terminology (CPT*) Editorial Panel revised the office/outpatient evaluation and management (E/M) codes (99202-99205, 99211-99215). For CPT 2023, the panel has revised additional families of E/M codes to be consistent with ...

  17. PDF MLN906764 Evaluation and Management Services Guide 2023-08

    Split (or Shared) E/M Services. CPT Codes 99202-99205, 99212-99215, 99221-99223, 99231-99239, 99281-99285, & 99291-99292. A split (or shared) service is an E/M visit where both a physician and NPP in the same group each personally perform part of a visit that each 1 could otherwise bill if provided by only 1 of them.

  18. Outpatient E/M Coding Simplified

    For outpatient E/M coding, medical decision making now has three components: Number and complexity of problems addressed at the encounter, Amount and/or complexity of data to be reviewed and ...

  19. Look to These 5 Tips to Improve Your Inpatient Coding : E/M Coding

    Here are five things you should be doing any time your urologist admits a patient for inpatient care and provides services for them during their stay. 1. Know These Key Definitions Before Reporting Initial Services. At the end of 2022, CPT® deleted the initial, subsequent, and discharge observation service codes (99218-99220, 99224-99226, and ...

  20. Billing for Care after the Initial Outpatient Postpartum Visit: The

    The current mechanisms to bill for obstetric care include billing each office visit as an appropriate Evaluation & Management (E/M) service and billing the delivery CPT codes (59409, 59514, 59612, 59620), or utilizing the global maternity codes. After the initial postpartum period (no later than 12 weeks after birth) care should not be covered ...

  21. The 2021 Office Visit Coding Changes: Putting the Pieces Together

    The American Medical Association (AMA) has established new coding and documentation guidelines for office visit/outpatient evaluation and management (E/M) services, effective Jan. 1, 2021. The ...

  22. 2023 Changes to the Inpatient and Consultation E/M Codes

    When the service at a separate site is reported and the initial inpatient or observation care service is a consultation, CPT instructs not to report codes 99221 to 99223 or 99252 to 99255. Instead, the consultant should report the subsequent hospital inpatient or observation care codes ( 99231 to 99233) for the second service on the same date.

  23. CPT® Code

    Hospital Inpatient and Observation Care Services. 99221-99223. Initial Hospital Inpatient or Observation Care. 99231-99233. Subsequent Hospital Inpatient or Observation Care. 99234-99236. Hospital Inpatient or Observation Care Services (Including Admission and Discharge Services) 99238-99239.