Billing for Hospitalists: Current Procedural Terminology (CPT) codes
The following are some of the codes we use on a day to day work as a hospitalist. If you want to know accurate meaning and to know how much documentation is needed for each code, simply google “CPT 99221” or “CPT ____Code number]”.
First half of this page will show the CPT code, what it is used for, dollar amount paid and RVUs assigned.
Second half shows tables with CPT codes and how much documentation is needed and how much complexity is included in each CPT code.
Initial H&P Billing for “Inpatient” status”: Most of the admissions from ER are High risk, Some are Moderate risk and very few are low risk.
| Admission CPTs | |||
| CPT Code | Description | Dollars Paid | RVUs assigned |
| 99221 | INIT IP HOSP CARE LOW SEVERITY | 100 | 1.9 |
| 99222 | INIT IP HOSP CARE MOD SEVERITY | 140 | 2.6 |
| 99223 | INIT IP HOSP CARE HIGH SEVERITY | 200 | 3.9 |
Subsequent/’Follow Up’ Inpatient Status Hospital Care Billing: Most of the follow up visits that we see after initial admission are for minor complication and some are for Significant problem when you need to spend more time for taking care of the patient. 99231 is billed when patient is just waiting for placement typically.
| Follow-up CPTs | ||||
| CPT Code | Description | Time | Dollars Paid | RVUs Assigned |
| 99231 | SUBSQ IP HOSP CARE LOW SEVERITY=responding to Treatment | 15min | 40 | 0.8 |
| 99232 | SUBSQ IP HOSP CARE MOD SEVERITY=Minor complication | 25min | 75 | 1.4 |
| 99233 | SUBSQ IP HOSP CARE HIGH SEVERITY=Significant problem | 35min | 105 | 2.0 |
For time-based coding, document the number of minutes spent and that greater than 50% of that time a face to face counseling was given to the patient/family on ……….(whatever the patient’s care plan is.)
Discharge Billing: Most discharges especially if they are being discharged to a facility like a Nursing home or Rehab, take more than 30min to discharge unless someone is going home and was in the hospital very briefly.
| Discharge CPTs | |||
| CPT Code | Description | Dollars Paid | RVUs assigned |
| 99238 | HOSPITAL IP DISCHARGE DAY, <30 MIN | 75 | 1.3 |
| 99239 | HOSPITAL IP DISCHARGE DAY, >30 MIN | 115 | 1.9 |
Same day admit and discharge: Patients who are on observation and are discharged the same day of admission, the following bills are used in gradually increasing intensity of billing from left to right.
99234 99235 99236
Initial H&P Billing for “Observation” status”: History and Physical for patients on observation uses the following codes in increasing intensity from left to right. Most are high intensity [99220] and some are 99219 and very few are 99218.
| Admission CPTs | |||
| CPT Code | Description | Dollars Paid | RVUs assigned |
| 99218 | INIT OBS CARE LOW SEVERITY | 100 | 1.9 |
| 99219 | INIT OBS CARE MOD SEVERITY | 140 | 2.6 |
| 99220 | INIT OBS CARE HIGH SEVERITY | 180 | 3.6 |
Observation follow up: These are the three codes that are used when we see the patients on observation for a follow up visit. Intensity of coding goes up from left to right. Most of the follow ups are 99225. Very few are 99226.
| Follow Up CPTs | |||
| CPT Code | Description | Dollars Paid | RVUs assigned |
| 99224 | SUBSQ OBS CARE LOW SEVERITY | 40 | 0.8 |
| 99225 | SUBSQ OBS CARE MOD SEVERITY | 75 | 1.4 |
| 99226 | SBSQ OBS CARE HIGH SEVERITY | 105 | 2.0 |
Observation Discharge: This is the bill used whenever the patient is discharged from observation status whether the patient is in the hospital for one day or one week on observation status.
| Discharge CPTs | |||
| CPT Code | Description | Dollars Paid | RVUs Assigned |
| 99217 | OBSERVATION CARE DISCHARGE | 75 | 1.3 |
The following are the consults codes that we use. Most of the codes are inpatient consult codes as we see the patients already admitted. Sometimes, we consult on a patient in the ER and that patient goes home if admission is not needed. In those cases, we use outpatient consult codes. The intensity goes up as we go down these codes. Most of the consults are 99254 but some can be 99255. Very rarely, especially when we consult very stable orthopedics patients, we bill low complexity code 99253.
| Consults: | In-Patient | $ | RVUs | Out-Patient | $ | RVUs |
| Problem Focused | 99251 | 70 | 1.02 | 99241 | 60 | 0.64 |
| Expanded Problem Focused | 99252 | 100 | 1.52 | 99242 | 90 | 1.34 |
| Low Complexity | 99253 | 130 | 2.30 | 99243 | 120 | 1.88 |
| Moderate Complexity | 99254 | 190 | 3.31 | 99244 | 175 | 3.02 |
| High Complexity | 99255 | 230 | 4 | 99245 | 225 | 3.77 |
Before going further, it will help to have a look into the documentation of patient encounter notes.
Here we will see how much documentation is needed for each CPT mentioned above.
CC=Chief complaint, HPI=History of present Illness, ROS=Review of Systems, PFSH=PMH, Family history, Social History, OS=Organ System,
Need all 3 components
| Level | History | Exam | MDM |
| 99221 99218 Detailed | CC HPI 4 ROS 2-9 PFSH 1 | 5 + OS 12+ Bullets | Straightforward Low Complexity |
| 99222 99219 Comprehensive | CC HPI 4 ROS 10+ PFSH3 | 8+ OS 1 OS Full 18+ Bullets (2-9) | Moderate Complexity |
| 99223 99220 Comprehensive | CC HPI4 ROS 10+ PFSH 3 | 8+ OS 1 OS Full 18+ Bullets (2-9) | High Complexity |
Need only two (2) components
| Level | History | Exam | MDM |
| 99231 99224 Problem Focused | CC HPI 1-3 ROS – NA PFSH – NA | 1 +OS 1 Bullet | Straightforward Low Complexity |
| 99232 99225 Expanded Problem Focused | CC HPI 1-3 ROS 1 PFSH – NA | 2+ OS 6+ Bullets | Moderate Complexity |
| 99233 99226 Detailed | CC HPI – 4 ROS 2-9 PFSH – NA | 5+ OS 12+ Bullets | High Complexity |
| Level | History | Exam | MDM |
| 99201 / 99211 99281 / 99241/ 99251 Problem Focused | CC HPI – 1-3 ROS – NA PFSH – NA | 1+OS 1 Bullet | Straight Forward |
| 99202 /99212 99282 / 99242/ 99252 Expanded Problem Focused | CC HPI – 1-3 ROS – 1 PFSH – NA | 2+ OS 6+ Bullets | Straight forward |
| 99203 / 99213 99283/ 99243/ 99253 Detailed | CC HPI – 4, 3 chronic ROS – 2-9 PFSH – 1 | 5+ OS 12+ Bullets | Low Complexity |
| 99204/ 99214 99284/ 99244/ 99254 Comprehensive | CC HPI – 4, 3 chronic ROS – 10 PFSH – 3 | 8+ OS 1 OS Full 18+ Bullets (2-9) | Moderate Complexity |
| 99205/ 99215 99285/ 99245/ 99255 Comprehensive | CC HPI – 4, 3 chronic ROS – 10 PFSH – 3 | 8+ OS 1 OS Full 18+ Bullets (2-9) | High Complexity |
