Initial Hospital Care

Tags: cpt inpatient em

Code Range

99221-99223 - Initial hospital care per day

Overview

Billed for the first hospital encounter by the admitting physician/specialty.

Code Selection

Code	MDM	Typical Time
99221	Low	40 min
99222	Moderate	60 min
99223	High	80 min

Requirements

One Per Admission

Frequency

Only one initial hospital care code per admission per physician/specialty group.

Admitting Physician

• Physician who writes admission order
• Manages overall care
• May use modifier AI (Medicare)

Documentation Elements

Element	Requirement
History	Chief complaint, HPI, ROS, PMH
Exam	Systems examined
MDM	Problems, data, risk
Time	If using time-based selection
Plan	Treatment, tests, consultations

Same Day Scenarios

Scenario	Billing
ED visit + Admission	Bill initial only
Observation + Admit	Bill initial only
Transfer from SNF	Bill initial hospital

ED Services

If patient seen in ED and admitted same day by same physician, bill initial hospital care only.

Modifier Usage

Modifier	When to Use
-AI	Medicare attending physician
-25	If procedure same day
-57	If decision for surgery

00 Inpatient ProFee Coding MOC M Codes Subsequent Hospital Care