cpt 99221, cpt code 99221, 99221 cpt code

CPT 99221 | Initial E/M For Hospital Inpatient Or Observation Care

CPT code 99221 can be used to report a patient’s initial evaluation and management during a hospital inpatient or observation stay. The total time spent with the patient is at least 40 minutes and requires a low level of medical decision-making.

What Is CPT Code 99221?

CPT 99221 can be used for initial hospital inpatient or observation care visits and reports the evaluation and management services of low-level medical decision-making.

The provider must spend at least 40 minutes with the patient on the encounter date, including both face-to-face and non-face-to-face activities.

The provider may take the patient’s history, perform a physical examination, and review and analyze data related to the patient’s condition.

The code also considers the number and complexity of the patient’s problems, as well as the risk of complications, morbidity, and mortality related to patient management.

Description

The CPT book describes CPT code 99221 as: “Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low-level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.”

Procedure

The provider meets with patients for the first time during their hospital stay for inpatient or observation care and conducts an evaluation and management (E/M) service.

The visit requires low-level decision-making and takes at least 40 minutes on a single date.

The 99221 CPT code includes:

  • Taking the patient’s history.
  • Performing an examination.
  • Determining the appropriate level of care based on the patient’s condition.

The time spent on the encounter date includes both face-to-face and non-face-to-face activities. It considers the complexity of the patient’s condition, the amount and complexity of data to review, and the potential risks of complications.

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