This article will define CPT Code 99232, explain the medical necessity to report CPT 99232, the guidelines and clinical examples of CPT 99232.
CPT Code 99232 Description
CPT Code 99232 is defined by the CPT manual as follows (the text in Italic is the official definition of CPT 99232):
Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of the 3 key components:
- Component 1: An expanded problem focused interval history
- Component 2: An expanded problem focused examination
- Component 3: Medical decision making of moderate complexity
Counselling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient’s hospital floor or unit.
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.
CPT Code 99232 Examples
Subsequent hospital visit for a patient with venous stasis ulcers who developed fever and red streaks adjacent to the ulcer. (Dermatology/Internal Medicine/Family Medicine)
Subsequent hospital visit for a 66-year-old male for dressing changes and observation, Patient has had a myocutaneous flap to close a pharyngeal fistula and now has a low-grade fever. (Plastic Surgery)
Subsequent hospital visit for a 54-year-old female admitted for myocardial infarction, but who is now having frequent premature ventricular contractions. (Internal Medicine)
Subsequent hospital visit for an 80-year-old patient with a pelvic rim fracture, inability to walk, and severe pain, now 36-hours post-injury, experiencing urinary retention. (Orthopaedic Surgery)
Subsequent hospital visit for a 17-year-old female with fever, pharyngitis, and airway obstruction, who after 48 hours develops a maculopapular rash. (Pediatrics/Family Medicine)
Follow-up hospital visit for a 32-year-old patient admitted the previous day for corneal ulcer. (Dermatology)
Follow-up visit for a 67-year-old male with congestive heart failure who has responded to antibiotics and diuretics and has now developed a monoarthropathy. (Internal Medicine)
Follow-up hospital visit for a 58-year-old male receiving continuous opioids who is experiencing severe nausea and vomiting. (Pain Medicine)
Subsequent hospital visit for a patient after an auto accident who is slow to respond to ambulation training. (Physical Medicine & Rehabilitation)
Subsequent hospital visit for a 14-year-old with unstable bronchial asthma complicated by pneumonia. (Allergy & Immunology)
Subsequent hospital visit for a 50-year-old diabetic, hypertensive male with back pain not responding to conservative inpatient management with continued radiation of pain to the lower left extremity. (Orthopaedic Surgery)
Subsequent hospital visit for a 37-year-old female on day five of antibiotics for bacterial endocarditis, who still has low-grade fever. (Cardiology)
Subsequent hospital visit for a 54-year-old patient, post Ml (myocardial infarction), who is out of the CCU (coronary care unit) but is now having frequent premature ventricular contractions on telemetry. (Cardiology/Internal Medicine)
Subsequent hospital visit for a patient with neutropenia, a fever responding to antibiotics, and continued slow gastrointestinal bleeding on platelet support. (Hematology/Oncology)
Subsequent hospital visit for a 50-year-old male admitted two days ago for sub-acute renal allograft rejection. (Nephrology)
Subsequent hospital visit for a 35-year-old drug addict, not responding to initial antibiotic therapy for pyelonephritis. (Urology)
Subsequent hospital visit of an 81-year-old male with abdominal distention, nausea, and vomiting. (General Surgery)
Subsequent hospital care for a 62-year-old female with congestive heart failure, who remains dyspneic and febrile. (Internal Medicine)
Subsequent hospital visit for a 73-year-old female with recently diagnosed lung cancer, who complains of unsteady gait. (Pulmonary Medicine)
Subsequent hospital visit for a 20-month-old male with bacterial meningitis treated one week with antibiotic therapy; has now developed a temperature of 101 degrees. (Pediatrics)
Subsequent hospital visit for 13-year-old male admitted with left lower quadrant abdominal pain and fever, not responding to therapy. (General Surgery)
Subsequent hospital visit for a 65-year-old male with hemiplegia and painful paretic shoulder. (Physical Medicine &Rehabilitation)