EM Coding Alert

Question: When should I use 99221-99223 or 99234-99236 for inpatient care?

Michigan Subscriber

Answer: The basic difference between the codes is that 99234-99236 (New or Established Patient Office or Other Outpatient Consultation Services) represent the services of an initial hospital service and a discharge service performed on the same calendar date. This means your documentation must reflect the exact times for admission and discharge.

To bill 99234-99236, you must have a statement that shows the stay for observation care or inpatient hospital care was greater than eight hours but less than 24 hours,” If the admission is greater than 24 hours, then you would use 99221-99223 (New or Established Patient Initial Hospital Inpatient Care Services) for the initial day of hospital care.

Knowing which provider can, and cannot, bill these codes is a typically problematic issue with inpatient care. But one easy way to break it down is to remember that for the inpatient initial visits, only one physician can be the admitting physician and only the admitting physician can use codes 99221-99223. All other providers should bill the inpatient E/M codes that describe their participation in the patient’s care (i.e., subsequent hospital visit or inpatient consultation).

In a subsequent hospital visit example, if Provider A sees the patient in the morning and Provider B, who is covering for A, sees the same patient in the evening, the notes for both services are combined and only one subsequent hospital visit is coded. However, if two physicians see the patient, and they are in different specialties and are seeing the patient for different reasons (i.e., different diagnosis), then both may bill a subsequent hospital visit based on that physician’s note and the medical necessity of the service.