CPT code 99222 describes an initial hospital inpatient or observation care visit and involves E/M services for the patient. A moderate level of medical decision-making is required, and the provider spent at least 55 minutes on the encounter.
What Is CPT Code 99222?
CPT 99222 describes an initial hospital inpatient or observation care visit involving the evaluation and management of a patient.
The “medically appropriate history and/or examination” refers to taking the patient’s medical history and performing a physical examination as deemed necessary by the provider for the proper evaluation and management of the patient’s condition.
The “moderate level of medical decision-making” refers to the complexity involved in evaluating and managing the patient.
This can include the number of diagnoses or management options, the risk of complication, the amount and complexity of data to review and analyze, morbidity, and mortality related to patient management.
The provider performs face-to-face and non-face-to-face services and spends 55 minutes or more on the patient.
The CPT book describes CPT code 99222 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 a moderate level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.”
The provider conducts an initial evaluation and management (E/M) visit for a patient during their inpatient or observation stay in the hospital.
This includes evaluating the patient’s condition and deciding on their treatment plan.
The visit involves a moderate level of medical decision-making or at least 55 minutes of total time spent on the encounter on a single date.
The total time includes both face-to-face and non-face-to-face activities such as;
- reviewing the patient’s medical records;
- documenting the encounter;
- communicating with other providers;
- examining the patient,
- interpreting test results
- communicating test results; and
- ordering tests.
The visit may also include taking the patient’s history and performing a physical examination as deemed appropriate by the provider.