Now that your practice has been applying the new inpatient E&M (99221-99233) coding rules for nearly two months, you may have questions about how to apply them. After all, utilizing codes in real-world scenarios can be vastly different than simply reading descriptors in code books.
That’s why we’re sharing three examples that can help every coder select the most appropriate codes to help make your E&M coding a breeze.
Example 1: Initial Inpatient Visit
Your provider admits a patient to the hospital for evaluation of pneumonia and orders the administration of intravenous antibiotics. He spends 40 minutes with the patient and utilizes a moderate level of medical decision-making (MDM) due to the acute illness with systemic symptoms and the decision regarding hospitalization.
When reviewing your coding options, you come across two choices:
- 99221 (Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.)
- 99222 (Initial hospital inpatient or observation care, per day, … moderate level of medical decision making … 55 minutes must be met or exceeded.)
In this case, although the total time spent only meets the criteria for 99221, the MDM is moderate, which qualifies for 99222. Because CPT 2023 allows you to select your inpatient code based on either time or MDM, you should select 99222, since you meet the MDM requirements for it and it’s the higher-paying code.
Example 2: Subsequent Hospital Visit
The physician sees a patient for a follow-up visit in the hospital. The patient has had COPD for four years and is now experiencing a COPD flare, making it difficult for her to breathe. The physician goes over the patient’s test results and consults with two other providers because her blood sugar is fluctuating wildly and is uncontrolled with insulin. The provider then talks to the patient’s family and orders additional medications. The physician spends 55 minutes on the patient’s care and documents a moderate level of medical decision-making.
For this chart, you have two main options:
- 99232 (Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.)
- 99233 (Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.)
The moderate level of MDM only justifies 99232, while the 55 minutes spent qualifies you for 99233. As with the initial inpatient codes, you can choose either MDM or time spent, so you’ll go with the higher-level code, 99233.
Example 3: Same-Day Admit/Discharge
The doctor sees a patient for chest pain, and nitroglycerine is administered, but the chest pain persists. Because his cardiac enzymes remain elevated, the patient is admitted to the hospital. However, several hours later, the chest pain subsides. The patient is discharged home with an angina diagnosis.
The provider documents a moderate level of MDM and 70 minutes with the patient. In this case, you’ll choose a same-day admit and discharge code instead of a hospital care code. And because the MDM and time spent both justify the same code, you’ll report 99235 (Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 70 minutes must be met or exceeded.)
The E/M coding guidelines changed dramatically this year—without help, it can be difficult to code properly. Let expert Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, help! During her 90-minute online training event, “Master New 2023 E/M Coding Changes,” Kim will walk you through the details you need to know so you can code correctly this year. Sign up today!
 | Subscribe to Healthcare Practice Advisor |
| Get actionable advice to help improve your practice’s reimbursement, compliance, and success in this weekly eNewsletter. | |
| |