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Subsequent Hospital Care Evaluation and Management (E&M) Codes (GEN)
Posted November 1, 2007
Subsequent hospital care evaluation and management (E&M) services have been identified in the past as a leading source of Comprehensive Error Rate Testing (CERT) errors. These codes include reviewing the medical record, the results of diagnostic studies, and changes in the patient's status as noted in the history, physical, and response to management since the last assessment by the physician.
One would expect a progression in the use of the codes as the patient's more serious state requiring in-hospital care is improved and the patient is appropriate for discharge.
- CPT code 99233 is the high level of subsequent hospital care and requires two of three key components: detailed interval history, detailed examination, and medical decision making of high complexity. Usually, the patient is unstable or has developed a significant complication or a significant new problem.
- CPT code 99232 is an expanded problem focused interval history, an expanded problem focused examination, and entails medical decision making of moderate complexity. Usually, the patient is responding inadequately to therapy or has developed a minor complication.
- CPT code 99231 is a problem focused interval history, a problem focused examination, and medical decision making that is straight-forward or of low complexity. Usually, the patient is stable, recovering, or improving.
Although these codes are not time codes, the estimated time of 35 minutes, 25 minutes, and 15 minutes for the codes, respectively, in relation to time at the bedside and on the hospital floor or unit in service of that one patient, provides some guidance. Again, the requirement is at least two of the three key components. Counseling and coordination of care may also be necessary. The documentation for subsequent patient visits per day must be appropriate to the level of E&M service claimed. It would not be expected that on the day before discharge that the E&M service would be 99233. Once would expect a reasonable progression of CPT code levels with the variations justified in the documentation.
For a more detailed review, one may go to the CPT code book appropriate to the year of service. On the last hospital day the patient is discharged and the appropriate discharge code is billed by the attending physician. Physicians other than the attending physician providing concurrent care are to use subsequent hospital care codes appropriate to the service rendered and documented. The documentation should be succinct and describe the essentials of the patient's status to allow a judgment that the E&M service rendered is reasonable and necessary to that described status, decision making, and actions taken. |
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