99232 cpt code

99232 CPT Code (2022) – Description, Guidelines, Reimbursement, Modifiers & Examples

99232 CPT Code is used for billing services when rendered after the first visit of a patient’s inpatient hospital admission by a clinician or supervising physician, or other qualified healthcare professionals.

CPT code 99232 is reported on a day-by-day basis and appropriate to report for either a new patient or an established patient. 

99232 CPT Code Description

Subsequent hospital care is reported by three CPT codes (99231-99233). These categories (CPT Codes 99231-99233) require at least two key components out of 3 Components.

CPT 99231 requires problem-focused examination and problem-focused history. A low level of MDM is needed and typically requires 15 minutes of total time spent by the physician and other qualified health clinicians.

For instance, the patient presents minor or self-limited problems like minor traumatic injury of an extremity. CPT 99232 requires expanded problem history and examination with a moderate level of MDM, which typically requires 25 minutes of total time.

For example, a patient presented with flank pain, hematuria, head injury with loss of consciousness is considered moderate complexity of MDM.

CPT code 99233 will be billed when a physician or other clinician makes detailed history and examination, which requires 35 minutes spent on the patient’s hospital floor or unit. 

All these 3 CPT subsequent inpatient care codes require the following elements:

  • Medical records reviewed by a physician
  • Diagnostic test results
  • Update the status of patients from the last visit. Changes were made for the patient’s treatment and medication decision-making and any changes to the patient’s status, such as physical condition response to treatments.

The 99232 CPT code subsequent care service cannot be billed on the date of the patient’s admission, and it would be considered from 2nd day of hospital decision.

An emergency hospital visit and same-day discharge inpatient or observation status cannot be billed with 99232 CPT on the same day by the same physician.

Documentation must support that nature of the problem and treatment decision were medically necessary and appropriate.

CPT (Current Procedural Terminology) 99232 is billed when subsequent hospital care is provided to a patient in one day by a physician or other qualified healthcare professional, and it requires 2 out of three components that must be met which are as follows:

  • An expanded problem focused interval history
  • An expanded problem focused examination
  • Medical decision making of moderate complexity

If the service is provided to a patient by a Counseling physician, and/ or coordination of care by agencies or other qualified healthcare professionals must reflect the patient’s current condition and treatment of the patient and/or family needs.

CPT 99232 could be reported based on MDM (Medical Decision Making) or Time. It typically needs 25 minutes of the physician during the coordination of care time spent on the patient’s floor or unit.

99232 CPT Code Billing Guidelines

CPT 99232 is appropriate to the bill when a second hospital inpatient visit occurs by a Physician or other healthcare qualified Clinician.

CPT 99232 does not differentiate between new patients and established ones. It can be billed with either a new patient or an established patient.

CPT 99232 requires 2 out of 3 components which are as follows:

Expanded problem-focused history: It requires at least 1-3 HPI elements, one ROS system, and one history component is required 1 out of 3 components (PFSH).

Expanded problem-focused Exam: It requires 2-4 systems as 95 documentation and 6-11 bullets required for 97 documentations.

Moderate MDM: It requires at least 2 out of three components of MDM that must be met on that basis of risk, diagnostic or treatment, Data management services like Medicine, Laboratory Medicine, Medicine, Medicine, review, counseling, Interpretation of services. If time is mentioned in the medical notes, it is appropriate to bill based on time instead of MDM, which typically requires 25 minutes on the patient’s hospital floor or unit.

Only one service can be provided of CPT 99232 in one day by the same physician or other qualified healthcare professional.

CPT 99232 can be billed together in combination with Initial hospital care visit CPT codes (99221-99223), and the modifier is also not applicable according to NCCI (National Correct Coding Initiative).

Similarly, CPT 99232 can be billed in conjunction with same-day Hospital discharge service CPT codes (99238-99239). Moreover, it is also allowed to be billed with same day Inpatient status or Observation status CPT Codes (99234-99236) 

Emergency CPT codes (99281-99285) are also not allowed to bill together with CPT 99232, and the modifier is also not applicable.

Q3014 is applicable when the hospital provides telemedicine service as an origin site to other outpatient hospital patients.

Modifiers

This is the following list of modifiers that are applicable with CPT 99234: 57, 24, 25, 95, 99, AI, AR, AQ, CC, CS, CR, EY, ET, G0, GA, GJ, GK, GQ, GR, GT, GU, GY, GZ, Q5, Q6, QJ XK, TH

The most frequent modifier used with CPT 99232 is 24, 25, and 95.

Modifier 25 will be appended with CPT 99232 when services are done in conjunction with other services that are not normally billed together on the same day.

While 24 will be appended with services done in the postoperative period with unrelated procedures or services.

Modifier 95 will be attached to CPT 99232 if service is provided as a telehealth visit.

cpt code 99232

CPT Code 99232 Reimbursement

The total cost and RUVS of CPT 99232 are as follows:

RUVS 2.20 and cost $76.21 for Non-facility

RUVS 2.20 and cost $76.21 for Facility

If telehealth services are provided to a patient, it is appropriate to bill CPT 99232 by appending modifier 95. Likewise, it is appropriate to bill CPT code Q3014 when Hospital provides telehealth service to an outpatient hospital patient. 

Examples

The following examples are when CPT 99232 can be used.

Example 1

The patient is a thirty-nine-year-old male without medical problems for follow-up inpatient hospital visits after a slip and fall evaluation. Pt was intoxicated and fell, hitting the back of his head.

He did not suffer any LOC, nausea, or vomiting. However, he has continued to bleed from the large laceration on his head, so he presents to the ED for further evaluation.

VSS stable. Physical shows 7 cm laceration to the occiput that is actively bleeding. CT head, washout, and staple.

Example 2 

A 65-year-old male who denies medical history was admitted yesterday to evaluate lower back pain status post rear-end MVC.

The patient reports he was a restrained driver in a vehicle that stopped at a stoplight when the car behind him hit the brakes and slid on the rain, striking him in the rear end. He reports cosmetic damage to the vehicle, still an operative condition.

He denies any airbag deployment and had self-extrication from the vehicle. He reports initially had no pain, but as time is passed, he began to feel a tightness in the right side of his lower back.

He denies any saddle anesthesia, incontinence of bladder or bowel, urinary retention, history of IV drug use, or history of cancer. He denies head trauma or loss of consciousness. Physician orders multiple diagnostics tests and medications for treatment.

Example 3

A 26-year-old male with h/o COPD for subsequent care hospital visit for c/o atraumatic pain and swelling to the medial aspect of right elbow x 4 days. This morning developed left upper back pain, intermittent stools, and mild nausea over the past seven days.

The patient reports having a fear of dying and feels very nervous. The patient is currently undergoing physical therapy for right shoulder pain. The patient denies fever, chills, vomiting, abdominal pain, palpitations, shortness of breath, chest pain, urinary complaints. The physician ordered CT and X-rays of the shoulders.

Example 4

The patient is a 46-year-old male with a PMHx of Thyroid cancer c/b dysphagia s/p G-tube placement in 2017 who had a follow-up visit with G-tube issues.

The patient states that he came to the hospital because his G-tube suddenly popped out without clear cause three days ago. He was able to replace the tube without difficulty.

However, he has acute worsening of chronic pain and discharges at the stoma that first began in May of 2018 after tube replacement in an outside emergency department.

He describes dark brown discharge and occasional mild bleeding at the site, as well as pain that has waxed and waned in intensity. The physician ordered medicine and diagnostic studies for further evaluation.

Example 5

A 29-year-old male with a PMH of obesity and a strong family cardiac history was admitted to the hospital two days ago for chest pain x 4 days. He reports an intermittent sometimes stabbing and other times tugging sensation, which lasts 6 to 7 minutes.

He denies radiation. He is reporting some new-onset pain with breathing today. The patient is not currently experiencing symptoms while being evaluated. He reports an episode of chest pain in the waiting room.

The patient is also reporting random palpitations during which he feels his heart is beating very strongly. The physicians ordered further laboratory, radiology tests, and medication treatment. If the results get normal, the patient will be discharged tomorrow after evaluation.

CPT 99231 – 99233 Initial & Subsequent Hospital Care

CPT codes 99231 – 99233 are used to interpret subsequent hospital care. These CPT codes need documentation of the history of problem focused, expanded problem focused, or detailed levels.

The exam requires an equal level of documentation. Medical decision making documentation should support straightforward, low, moderate, or high complexity. The nature of the issue presented generally determines the levels of history and physical examination obligated.

CPT code 99231: CPT 99231 generally requires documentation to support patient stability, recovery, or improvement.

CPT code 99232: CPT 99232 generally requires documentation to support the patient not responding competently to therapy or has acquired a minor complication. Such minor complications could comprise of careful management of co-morbid conditions requiring several active treatments.

CPT code 99233: CPT 99233 generally requires documentation to argue that a patient is not stable or has a major new issue or complication.

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