Inpatient E&M Codes

Tags: cpt em inpatient

Overview

Inpatient E/M codes cover hospital visits for admitted patients. Updated significantly in 2023.

Initial Hospital Care (99221-99223)

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

First Visit Only

Initial hospital care codes are billed once per admission by the admitting physician/specialty.

Subsequent Hospital Care (99231-99233)

Code	MDM Level	Typical Time
99231	Low	25 min
99232	Moderate	40 min
99233	High	55 min

Hospital Discharge Services (99238-99239)

Code	Description	Time
99238	Discharge day management	≤30 min
99239	Discharge day management	>30 min

Discharge Billing

• Only bill on actual discharge date
• Includes final exam, paperwork, prescriptions
• Cannot bill other E/M same day (except critical care)

2023 E/M Changes Summary

Change	Detail
Observation Codes Deleted	99218-99220 removed
Time Definition	Total time on date of service
MDM Focus	Primary selection criterion
Prolonged Services	New codes 99417+

Code Selection Criteria

Medical Decision Making (MDM)

1. Problems: Number and complexity
2. Data: Amount and complexity reviewed
3. Risk: Risk of complications/morbidity

Time

• Total time spent on date of encounter
• Includes: Face-to-face, documentation, care coordination
• Excludes: Travel, teaching (for teaching physicians)

Time Documentation

If using time for code selection, document total time and activities performed.

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📊 MDM Quick Reference

2 Out of 3 Rule

To qualify for an MDM level, 2 of the 3 elements (Problems, Data, Risk) must meet the threshold.

Level	Problems	Data	Risk
Straightforward	1 Self-limited	1 Category	Minimal (OTC)
Low	1 Stable Chronic	2 Categories	Low (Rx, PT)
Moderate	1 Acute Complicated	3 Categories	Moderate (IV, Hosp)
High	1 Life-Threatening	4 Categories	High (Emergency)

Data Categories:

1. Tests/Docs Reviewed
2. Independent Historian
3. External Provider Discussion
4. External Record Review

Risk Examples:

• Low: Prescription management
• Moderate: Hospital admission, Major surgery
• High: Life-threatening illness

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00 Inpatient ProFee Coding MOC Critical Care Codes Prolonged Services