hospitalist billing
Billing,  Hospitalist

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 CodeDescriptionDollars PaidRVUs assigned
99221INIT IP HOSP CARE
LOW SEVERITY
1001.9
99222INIT IP HOSP CARE
MOD SEVERITY
1402.6
99223INIT IP HOSP CARE
HIGH SEVERITY
2003.9

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 CodeDescriptionTimeDollars PaidRVUs Assigned
99231SUBSQ IP HOSP CARE
LOW SEVERITY=responding to Treatment
15min 400.8
99232SUBSQ IP HOSP CARE
MOD SEVERITY=Minor complication
25min751.4
99233SUBSQ IP HOSP CARE
HIGH SEVERITY=Significant problem
35min1052.0

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 CodeDescriptionDollars PaidRVUs assigned
99238HOSPITAL IP DISCHARGE DAY, <30 MIN751.3
99239HOSPITAL IP DISCHARGE DAY, >30 MIN1151.9

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 CodeDescriptionDollars PaidRVUs assigned
99218INIT OBS CARE
LOW SEVERITY
1001.9
99219INIT OBS CARE
MOD SEVERITY
1402.6
99220INIT OBS CARE
HIGH SEVERITY
1803.6

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 CodeDescriptionDollars PaidRVUs assigned
99224SUBSQ OBS CARE
LOW SEVERITY
400.8
99225SUBSQ OBS CARE
MOD SEVERITY
751.4
99226SBSQ OBS CARE
HIGH SEVERITY
1052.0

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 CodeDescriptionDollars PaidRVUs Assigned
99217OBSERVATION CARE DISCHARGE751.3

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 $RVUsOut-Patient$RVUs
Problem Focused99251701.0299241600.64
Expanded Problem Focused99252 1001.5299242901.34
Low Complexity 99253   1302.30992431201.88
Moderate Complexity99254  1903.31992441753.02
High Complexity992552304992452253.77

 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                                                                        

LevelHistory ExamMDM
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

LevelHistoryExamMDM
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

LevelHistoryExamMDM
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

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