How To Use CPT Code 99234

CPT 99234 is a code used for hospital inpatient or observation care, including admission and discharge on the same date, requiring a medically appropriate history and/or examination and straightforward or low level of medical decision making. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99234.

1. What is CPT 99234?

CPT 99234 is a code used by medical professionals to bill for hospital inpatient or observation care services that involve evaluation and management (E/M) of a patient, including admission and discharge on the same date. The E/M service requires a medically appropriate history and/or examination and a straightforward or low level of medical decision making. This code is essential for medical coders and billers to accurately document and bill for these specific services.

2. 99234 CPT code description

The official description of CPT code 99234 is: “Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.”

3. Procedure

The 99234 CPT code procedure involves the following steps:

1. Admission of the patient to the hospital inpatient or observation setting.
2. Performing a medically appropriate history and/or examination.
3. Evaluating the patient’s condition and determining the level of medical decision making required (straightforward or low).
4. Providing necessary treatment and care during the hospital stay.
5. Discharging the patient on the same date as admission.
6. Documenting the encounter, including the history, examination, and medical decision making.

4. Qualifying circumstances

Patients eligible to receive CPT code 99234 services are those who require hospital inpatient or observation care, including evaluation and management, with admission and discharge on the same date. The E/M service must involve a medically appropriate history and/or examination and a straightforward or low level of medical decision making. Additionally, the total time spent on the date of the encounter must be at least 45 minutes for code selection.

5. When to use CPT code 99234

It is appropriate to bill the 99234 CPT code when a provider sees a patient for hospital inpatient or observation care involving evaluation and management, with an admission encounter and discharge encounter on the same date. The E/M service must involve a medically appropriate history and/or examination and a straightforward or low level of medical decision making. The total time spent on the date of the encounter must be at least 45 minutes for code selection.

6. Documentation requirements

To support a claim for CPT 99234, the following information must be documented:

• Date of service
• Admission and discharge times
• Medically appropriate history and/or examination performed
• Level of medical decision making (straightforward or low)
• Total time spent on the date of the encounter (at least 45 minutes)
• Diagnosis and treatment provided
• Any additional services or consultations performed during the hospital stay

7. Billing guidelines

When billing for CPT code 99234, it is essential to ensure that the documentation supports the claim, including the medically appropriate history and/or examination, level of medical decision making, and total time spent on the date of the encounter. Additionally, it is crucial to follow any payer-specific guidelines and rules related to billing for hospital inpatient or observation care services.

8. Historical information

CPT 99234 was added to the Current Procedural Terminology system on January 1, 1998. Since then, there have been several updates to the code description, with the most recent change occurring on January 1, 2023.

9. Similar codes to CPT 99234

Five similar codes to CPT 99234 and how they differentiate are:

• CPT 99217: This code is used for observation care discharge services only, not including admission and discharge on the same date.
• CPT 99218: This code is for initial observation care, requiring a detailed or comprehensive history, a detailed or comprehensive examination, and straightforward or low complexity medical decision making.
• CPT 99219: This code is for initial observation care, requiring a comprehensive history, a comprehensive examination, and moderate complexity medical decision making.
• CPT 99220: This code is for initial observation care, requiring a comprehensive history, a comprehensive examination, and high complexity medical decision making.
• CPT 99238: This code is for hospital discharge day management services, not including admission and discharge on the same date.

10. Examples

Here are 10 detailed examples of CPT code 99234 procedures:

1. A patient with a minor injury is admitted to the hospital for observation, receives treatment, and is discharged on the same day.
2. A patient with a mild respiratory infection is admitted to the hospital for observation, undergoes diagnostic testing, and is discharged on the same day.
3. A patient with a minor allergic reaction is admitted to the hospital for observation, receives medication, and is discharged on the same day.
4. A patient with a mild gastrointestinal issue is admitted to the hospital for observation, undergoes diagnostic testing, and is discharged on the same day.
5. A patient with a minor skin infection is admitted to the hospital for observation, receives treatment, and is discharged on the same day.
6. A patient with a mild headache is admitted to the hospital for observation, undergoes diagnostic testing, and is discharged on the same day.
7. A patient with a minor sprain is admitted to the hospital for observation, receives treatment, and is discharged on the same day.
8. A patient with a mild urinary tract infection is admitted to the hospital for observation, undergoes diagnostic testing, and is discharged on the same day.
9. A patient with a minor eye irritation is admitted to the hospital for observation, receives treatment, and is discharged on the same day.
10. A patient with a mild ear infection is admitted to the hospital for observation, undergoes diagnostic testing, and is discharged on the same day.