How To Use CPT Code 99232

CPT 99232 describes the subsequent hospital inpatient or observation care provided by a healthcare professional for the evaluation and management of a patient. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99232.

1. What is CPT Code 99232?

CPT 99232 can be used to describe the subsequent hospital inpatient or observation care provided by a healthcare professional for the evaluation and management of a patient. This code is used when the healthcare professional spends a medically appropriate amount of time on the encounter, which includes a moderate level of medical decision making or at least 35 minutes of total time on a single date.

2. Official Description

The official description of CPT code 99232 is: ‘Subsequent 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 moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.’

3. Procedure

1. The healthcare professional provides subsequent hospital inpatient or observation care for the evaluation and management of a patient.
2. The encounter involves a medically appropriate history and/or examination.
3. The healthcare professional determines the level of medical decision making required for the encounter or ensures that at least 35 minutes of total time is spent on a single date.
4. The healthcare professional performs various activities during the encounter, such as reviewing tests, performing exams or evaluations, counseling and educating the patient or caregiver, ordering tests, communicating with other healthcare providers, documenting the encounter, interpreting and communicating results, and coordinating care.
5. The healthcare professional may also take a patient history and perform a physical examination as necessary.

4. Qualifying circumstances

Patients eligible to receive CPT 99232 services are those who require subsequent hospital inpatient or observation care for the evaluation and management of their condition. The healthcare professional must provide a medically appropriate history and/or examination, or spend at least 35 minutes of total time on a single date. The level of medical decision making involved should be moderate.

5. When to use CPT code 99232

CPT code 99232 should be used when a healthcare professional provides subsequent hospital inpatient or observation care for the evaluation and management of a patient. This code should be used when the encounter involves a medically appropriate history and/or examination, or when at least 35 minutes of total time is spent on a single date. The level of medical decision making should be moderate.

6. Documentation requirements

To support a claim for CPT 99232, the healthcare professional must document the following information:

• Medically appropriate history and/or examination performed
• Total time spent on the encounter, if using time for code selection
• Level of medical decision making involved
• Activities performed during the encounter, such as reviewing tests, performing exams or evaluations, counseling and educating the patient or caregiver, ordering tests, communicating with other healthcare providers, documenting the encounter, interpreting and communicating results, and coordinating care
• Signature of the healthcare professional providing the service

7. Billing guidelines

When billing for CPT 99232, ensure that the healthcare professional provides subsequent hospital inpatient or observation care for the evaluation and management of a patient. The encounter should involve a medically appropriate history and/or examination, or at least 35 minutes of total time on a single date. It is important to accurately document the level of medical decision making involved. CPT code 99232 should not be reported with other codes unless appropriate and supported by the documentation.

8. Historical information

CPT 99232 was added to the Current Procedural Terminology system on January 1, 1992. There have been no updates to the code since its addition.

9. Similar codes to CPT 99232

Five similar codes to CPT 99232 include:

• CPT 99231: This code is used for subsequent hospital inpatient or observation care with a low level of medical decision making or at least 15 minutes of total time on a single date.
• CPT 99233: This code is used for subsequent hospital inpatient or observation care with a high level of medical decision making or at least 50 minutes of total time on a single date.
• CPT 99238: This code is used for hospital discharge day management services provided to a patient who is discharged from an inpatient hospital stay.
• CPT 99239: This code is used for hospital discharge day management services provided to a patient who is discharged from an observation status.
• CPT 99291: This code is used for critical care services provided to a critically ill or critically injured patient, requiring constant attendance by a healthcare professional.

10. Examples

1. A physician providing subsequent hospital inpatient care for a patient recovering from surgery, spending 40 minutes on the encounter and involving a moderate level of medical decision making.
2. A nurse practitioner providing subsequent observation care for a patient with a respiratory infection, spending 30 minutes on the encounter and involving a moderate level of medical decision making.
3. A physician assistant providing subsequent hospital inpatient care for a patient with a chronic condition, spending 60 minutes on the encounter and involving a high level of medical decision making.
4. A specialist providing subsequent observation care for a patient with a complex medical condition, spending 45 minutes on the encounter and involving a high level of medical decision making.
5. A healthcare professional providing subsequent hospital inpatient care for a patient with multiple chronic conditions, spending 55 minutes on the encounter and involving a high level of medical decision making.
6. A physician providing subsequent observation care for a patient with a minor injury, spending 20 minutes on the encounter and involving a low level of medical decision making.
7. A nurse practitioner providing subsequent hospital inpatient care for a patient with a simple medical condition, spending 25 minutes on the encounter and involving a low level of medical decision making.
8. A physician assistant providing subsequent observation care for a patient with a minor illness, spending 15 minutes on the encounter and involving a low level of medical decision making.
9. A specialist providing subsequent hospital inpatient care for a patient with a rare disease, spending 50 minutes on the encounter and involving a high level of medical decision making.
10. A healthcare professional providing subsequent observation care for a patient with a common condition, spending 30 minutes on the encounter and involving a moderate level of medical decision making.