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12/07/2016

Correct Coding for Initial and Subsequent Visits for Inpatient Hospital and ER Patients

What are the proper CPT codes for an initial and subsequent visits for in-patient hospital and ER patients?

Below are the acceptable E&M codes that are payable for inpatient or ER services:

Initial Inpatient Hospital Visits:

99221: (Low complexity initial hospital visit, 30 minutes)

99222: (Moderate complexity initial hospital visit, 50 minutes)

99223: (High complexity initial hospital visit, 70 minutes)

Subsequent Inpatient Hospital Visits:

99231: (Low complexity subsequent hospital visit, 15 minutes)

99232: (Moderate complexity subsequent hospital visit, 25 minutes)

99233: (High complexity subsequent hospital visit, 35 minutes)

Inpatient Hospital Consultations (Only payable by some commercial HMOs- not for Medicare use):

99251: (Initial inpatient hospital consultation of a new or established patient, minor/self-limited, 20 minutes)

99252: (Initial inpatient hospital consultation of a new or established patient, low complexity, 45 minutes)

99253: (Initial inpatient hospital consultation of a new or established patient, moderate complexity, 55 minutes)

99254: (Initial inpatient hospital consultation of a new or established patient, moderate/high complexity, 80 minutes)

99255: (Initial inpatient hospital consultation of a new or established patient, high complexity, 110 minutes)

Emergency Room Visits:

99281: (Emergency room visit, self-limited/minor)

99282: (Emergency room visit, low/moderate severity)

99283: (Emergency room visit, moderate severity)

99284: (Emergency room visit, moderate/high severity)

99285: (Emergency room visit, high severity)

 

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