How To Use CPT Code 99233

CPT 99233 describes the subsequent hospital inpatient or observation care 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 99233.

1. What is CPT Code 99233?

CPT 99233 can be used to describe the subsequent hospital inpatient or observation care for the evaluation and management of a patient. This code is used when the provider spends a significant amount of time on the encounter, either at least 50 minutes or when there is a high level of medical decision making involved.

2. Official Description

The official description of CPT code 99233 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 high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.’

3. Procedure

1. The provider performs an evaluation and management service for a patient in the inpatient hospital or observation setting.
2. The total time spent on the date of the encounter is at least 50 minutes or the level of medical decision making involved is high.
3. Total time includes both face-to-face and non-face-to-face activities on the encounter date.
4. Activities may include reviewing tests, performing exams, 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 provider determines the nature and extent of the history and/or exam appropriate for the encounter.

4. Qualifying circumstances

CPT 99233 is used for subsequent hospital inpatient or observation care visits that require a medically appropriate history and/or examination and a high level of medical decision making. The provider must spend at least 50 minutes on the encounter on a single date or demonstrate a high level of medical decision making. The nature and extent of the history and/or exam required are determined by the provider.

5. When to use CPT code 99233

CPT code 99233 should be used for subsequent hospital inpatient or observation care visits that meet the criteria of a medically appropriate history and/or examination and a high level of medical decision making. It is important to accurately document the time spent on the encounter or the level of medical decision making involved to support the use of this code.

6. Documentation requirements

To support a claim for CPT 99233, the provider must document the following information:

• Medically appropriate history and/or examination
• Total time spent on the encounter on a single date, if using time for code selection
• Level of medical decision making involved, if not using time for code selection
• Activities performed during the encounter, such as reviewing tests, performing exams, counseling and educating the patient or caregiver, ordering tests, communicating with other healthcare providers, documenting the encounter, interpreting and communicating results, and coordinating care

7. Billing guidelines

When billing for CPT 99233, ensure that the encounter meets the criteria of a subsequent hospital inpatient or observation care visit with a medically appropriate history and/or examination and a high level of medical decision making. It is important to accurately document the time spent on the encounter or the level of medical decision making involved. CPT code 99233 should not be reported with other codes for services performed in the previous seven days. Prolonged services code 99418 should be used for encounters lasting 65 minutes or longer.

8. Historical information

CPT 99233 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 99233

Five similar codes to CPT 99233 include:

• CPT 99231: This code is used for subsequent hospital care visits that require a medically appropriate history and/or examination and a low level of medical decision making.
• CPT 99232: This code is used for subsequent hospital care visits that require a medically appropriate history and/or examination and a moderate level of medical decision making.
• CPT 99234: This code is used for initial hospital care visits that require a medically appropriate history and/or examination and a low level of medical decision making.
• CPT 99235: This code is used for initial hospital care visits that require a medically appropriate history and/or examination and a moderate level of medical decision making.
• CPT 99238: This code is used for hospital discharge day management services provided to a patient who is discharged from an inpatient hospital stay.

10. Examples

1. A provider spends 55 minutes on a subsequent hospital inpatient care visit, reviewing test results, performing an examination, and discussing treatment options with the patient.
2. A provider spends 60 minutes on a subsequent observation care visit, coordinating care with other healthcare providers, documenting the encounter, and communicating results to the patient.
3. A provider spends 50 minutes on a subsequent hospital inpatient care visit, reviewing the patient’s medical history, performing a physical examination, and making a high level of medical decisions regarding the patient’s treatment plan.
4. A provider spends 70 minutes on a subsequent observation care visit, ordering additional tests, interpreting and communicating results, and counseling the patient on their condition and treatment options.
5. A provider spends 45 minutes on a subsequent hospital inpatient care visit, reviewing the patient’s progress, discussing any changes in their condition, and making a moderate level of medical decisions regarding their ongoing care.
6. A provider spends 80 minutes on a subsequent observation care visit, coordinating care with other healthcare providers, documenting the encounter, and communicating results to the patient and their family.
7. A provider spends 55 minutes on a subsequent hospital inpatient care visit, reviewing test results, performing an examination, and discussing treatment options with the patient.
8. A provider spends 60 minutes on a subsequent observation care visit, coordinating care with other healthcare providers, documenting the encounter, and communicating results to the patient.
9. A provider spends 50 minutes on a subsequent hospital inpatient care visit, reviewing the patient’s medical history, performing a physical examination, and making a high level of medical decisions regarding the patient’s treatment plan.
10. A provider spends 70 minutes on a subsequent observation care visit, ordering additional tests, interpreting and communicating results, and counseling the patient on their condition and treatment options.