American Medical Association (AMA)

use of the following codes. Refer to codes 99221, 99222, 99223, 99231, 99232, 99233, 99238, and 99239 for information on individuals who were admitted to a hospital as inpatients or for observation care but were discharged on a separate date. The requirements for the codes 99234, 99235, and 99236 are that there must be two or more interactions on the same day, with at least one of these encounters being a discharge experience and the other encounters being initial admission encounters. Refer to codes 99221, 99222, and 99223 for information on a patient who was admitted and discharged within the same encounter (also known as "one encounter"). When you are reporting admission and discharge services that were completed on the same day, do not record 99238, 99239 in combination with 99221, 99222, or 99223. (The code 99463 should be used for discharge services provided to babies who were hospitalized and discharged on the same date.)

➢ 99234 Hospital inpatient or observation care for the management and evaluation of a patient who is recently admitted and released on the same day and who requires a medically necessary history and/or exam as well as straightforward or low-level medical judgments. Care like this is also called observation care.

For code selection, the total time on the day of the encounter must be at least 45 minutes, but it must be longer than that.

➢ 99235 Hospital inpatient or observation care for a patient who needs a medically adequate history and/or exam and a moderate level of medical decision-making. This includes admitting and releasing the patient on the same day.

To find the right code, the whole day of the encounter must last at least 70 minutes, and ideally, it should last longer.

➢ 99236 Hospital inpatient or observation care for a patient who needs a medically adequate history and/or exam and a lot of medical decisions to be made, including admission and discharge on the same day.

To find the right code, the whole day of the encounter must last at least 85 minutes, and ideally, it should last longer.

(Use prolonged services code 993X0 for services lasting 100 minutes or more.)

The American Medical Association's registered trademark is CPT. American Medical Association. Copyright 2022. Every right is retained. It should be noted that future CPT Editorial Panel (Panel) or Executive Committee actions may have an impact on CPT codes and/or descriptions. As a result, the CPT code set's code numbers and/or descriptor language may alter at the time of release. - 30 -