Preparing for the 2023 Evaluation & Management (E/M) Changes: Part 3

Hospital Inpatient and Observation Care Services, continued

Hospital Inpatient and Observation Care Services

The discussion continues related to Hospital Inpatient and Observation Care Services.  This conversation will focus specifically on discharge management related to these two services.  The guideline and language changes are based on the updates that are effective January 1, 2023.   

Guideline changes:  Hospital Inpatient and Observation Care Services (Including Admission and Discharge Services

The following codes are used to report hospital inpatient or observation care services provided to patient admitted and discharged on the same date of service.

For patients admitted to hospital inpatient or observation care and discharged on a different date, see 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239.

Codes 99234, 99235, 99236 require two or more encounters on the same date of which one of these encounters is an initial admission encounter and another encounter being a discharge encounter.  For a patient admitted and discharged at the same encounter (i.e., one encounter), see 99221, 99222, 99223. Do not report 99238, 99239 in conjunction with 99221, 99222, 99223 for admission and discharge services performed on the same date.

99234Hospital 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 straightforward or low-level medical decision making. When using total time – 45 minutes must be met or exceeded
99235Hospital inpatient or observation care, . . . and moderate level of medical decision making. When using total time – 70 minutes must be met or exceeded
99236Hospital inpatient or observation care, . . .and high level of medical decision making. When using total time – 85 minutes must be met or exceeded
(For services of 90 minutes or longer, use prolonged services code 993X0)

Guideline changes:  Hospital Inpatient or Observation Discharge Services

The hospital inpatient or observation discharge day management codes are to be used to report the total duration of time on the date of the encounter spent by a physician or other qualified health care professional for final hospital or observation discharge of a patient, even if the time spent by the physician or other qualified health care professional on that date is not continuous.  He codes include, as appropriate, final examination of the patient, discussion of the hospital stay, instructions for continuing care to all relevant caregivers, and preparation of discharge records, prescriptions, and referral forms.  These codes are to be utilized to report all services provided to a patient on the date of discharge, if other than the initial date of inpatient or observation status.  For a patient admitted and discharged from hospital inpatient or observation status on the same date, report 99234, 99235, 99236, as appropriate. 

Codes 99238, 99239 are to be used by the physician or other qualified health care professional who is responsible for discharge services.  Services by other physicians or other qualified health care professionals that may include instructions to the patient and/or family/caregiver and coordination of post-discharge services may be reported with 99231, 99232, 99233.

99238Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter
99239                More than 30 minutes on the date of the encounter

As a reminder, any E/M with a time designation in the code requires total time be included in the provider documentation.

Check out our other coding tips here.

References:  2023 CPT E/M descriptors and guidelines (ama-assn.org)

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