initial outpatient hospital visit cpt code

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Office/Outpatient E/M Codes

2021 e/m office/outpatient visit cpt codes.

The tables below highlight the changes to the office/outpatient E/M code descriptors effective in 2021.

More details about these office/outpatient E/M changes can be found at CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99XXX) Code and Guideline Changes.

All specific references to CPT codes and descriptions are © 2023 American Medical Association. All rights reserved. CPT and CodeManager are registered trademarks of the American Medical Association.

Download the Office E/M Coding Changes Guide (PDF)

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List With CPT Codes For New Patient Office Visits | Short & Long Descriptions and Lay-Terms

4 CPT codes describe the procedures for a new patient office visit . These codes are used to record the level of complexity of the evaluation, management, and medical decision-making during the visit. You can find a complete list of office visits for both established patients and new patients here.

1. CPT Code 99202

Lay-term: CPT code 99202 is used when a healthcare provider performs an office visit for a new patient that requires a medically appropriate history and/or examination and straightforward medical decision making. The total time spent on the encounter must be 15 minutes or more.

Long description: Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.

Short description: New patient office visit, straightforward medical decision making, 15 minutes.

1.2. CPT Code 99203

Lay-term: CPT code 99203 is used when a healthcare provider performs an office visit for a new patient that requires a medically appropriate history and/or examination and a low level of medical decision making. The total time spent on the encounter must be 30 minutes or more.

Long description: Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.

Short description: New patient office visit, low level medical decision making, 30 minutes.

1.3. CPT Code 99204

Lay-term: CPT code 99204 is used when a healthcare provider performs an office visit for a new patient that requires a medically appropriate history and/or examination and a moderate level of medical decision making. The total time spent on the encounter must be 45 minutes or more.

Long description: Office or other outpatient visit for the evaluation and management of a new 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, 45 minutes must be met or exceeded.

Short description: New patient office visit, moderate level medical decision making, 45 minutes.

1.4. CPT Code 99205

Lay-term: CPT code 99205 is used when a healthcare provider performs an office visit for a new patient that requires a medically appropriate history and/or examination and a high level of medical decision making. The total time spent on the encounter must be 60 minutes or more.

Long description: Office or other outpatient visit for the evaluation and management of a new 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, 60 minutes must be met or exceeded.

Short description: New patient office visit, high level medical decision making, 60 minutes.

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April 16, 2024

Coding for Observation Services

Cpt codes for observation services.

Beginning January 1, 2023 there are two sets of codes used for both inpatient status and observation level of care. Coding for observation services no longer has a distinct set of CPT® codes, those were deleted. Use 99221–99223 for initial inpatient or observation care services and use 99231–99233 for inpatient or observation subsequent visits. 99238 and 99239 are the discharge codes.

For admission and discharge on the same calendar date, use codes 99234—99236.

Medicare says, “Only the attending physician of record reports the discharge day management service.”

Place of service

Continue to report the correct place of service on the claim form, place of service 21 for inpatient hospital and place of service 22 for on campus—outpatient hospital. Observation is an outpatient service.

Consulting physicians

Following CPT® rules, a consulting physician would report inpatient consult codes 99252—99255 for the initial service. These are now defined as inpatient or observation services.  Use 99231—99233 for follow up visits. For patients with commercial insurance that still recognizes consultation codes, this is the correct coding for observation services.

Coding for observation services for Medicare patients seen in consultation

Medicare stopped recognizing consultation codes in 2010. Chapter 12 of Medicare’s Claims Processing Manual has not changed its instruction with the deletion of observation codes 99218—99220, 99224-99226, and 99217.  Their manual says “Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient’s observation services began. All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes.”

• For all payers, the admitting physician uses 99221-99223 for patients in observation level of care. Add modifier AI for Medicare.
• For commercial payers that recognize consults, the consulting physician uses 99252—99255 for patients in observation level of care.
• For Medicare patients, the consulting physician uses office and/or other outpatient codes 99202—99215. Keep in mind the definition of new patient. A new patient is a patient who has never been seen by that physician or their same specialty partner (in their group) for the past three years. Use these codes for the initial visit and subsequent visits.

CMS citations: Medicare Claims Processing Manual, Ch. 12, Section 30.6. 9 and 30.6.10

Additional Resources

• Download the E/M guide for more detailed information about coding for observation (and other E/M services)
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Last revised April 11, 2024 - Betsy Nicoletti Tags: hospital inpatient/observation

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Initial Inpatient or Observation Care Services – CPT

• Initial Inpatient or Observation Care Services – Medicare
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At first glance, AMA CPT coding in 2023 seems simplified in the Hospital Setting.  The distinct code set for Observation Services was deleted. The Initial Hospital Inpatient and Observation Care Services code sets merged into the 99221-99233 code set. The guidelines, however, have changed and application of the code set will depend on the patient’s “status”.

E/M Services Performed in Other Sites:

Here is the twist. In previous years, all services performed in other sites were bundled into the final destination hospital code. For example , if the patient was seen in the office and told to go to the hospital, their doc admitted them (same day), they would report only the Initial Inpatient Hospital service. In 2023, that’s now changed. Now, if you choose to report the E/M service, you can, with modifier -25 appended to the “other” E/M service code.

Consultative Services:

The catch, however, is if the initial inpatient service in the hospital is a consultative service, you will not be reporting 99221-99223, or an inpatient consultation code (99252-99255), you will instead report your consult with a SUBSEQUENT Hospital Visit Code, 99231-99233. This guidance pertains to the admitting physician (specialty/group practice).

This also holds true (according to AMA, page 23 ) “ if a consultation is performed in anticipation of, or related to, an admission by another physician or other qualified health care professional, and then the same consultant performs an encounter once the patient is admitted by the other physician or other qualified health care professional. This also applies whether the consultation occurred on the date of the admission, or, a date previous to the admission. It also applies for consultations reported with any appropriate code (eg, office or other outpatient visit or office or other outpatient consultation).”

Additionally, when reporting an initial hospital inpatient or observation care service, transition from observation level to inpatient, does not constitute a new stay.

Is there any GOOD news?

The good news is that the MDM and Time requirements are the same regardless of the patient’s “status” in the hospital (Initial Hospital Inpatient vs. Observation) when appropriately using the 99221-99233 code set.

I encourage everyone to read through the AMA definitions and guideline changes for 2023. More to come on this topic. CMS just released their CY23 final rule , and if you see Medicare patients, there is sure to be additional guidelines to layer on to this change. To get a sneak peek, turn to (page 504) to learn more about (3. Hospital Inpatient or Observation Care (CPT Codes 99218-99236). Stay tuned to the web site.

January 2023 Clarification:   Although CPT combined Inpatient Care and Observation Service codes, the original place of service still stands:

• Inpatient Services:  (POS 21)
• Observation Services: (POS 22)

If you would like additional training on these changes, please reach out to [email protected] .

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Coding for consults and readmissions

ICD-9 coding tips for consults and readmissions, with modifiers for subsequent visits to multiple physicians

Published in the September 2010 issue of Today’s Hospitalist

CONFUSED ABOUT HOW TO CODE a readmission or whether to wait until a patient is discharged to bill for your services? Questions on coding for consults and readmissions are just two of the questions I’ve received this month from readers. Read on for my advice.

Today’s Hospitalist’s Coding articles provide hospitalist physicians the practical tips they need to thoroughly document their services and maximize their reimbursements.

Readmissions I am wondering how to bill a patient’s readmission. The patient was discharged in the morning but readmitted that afternoon. Which services should we bill for the discharge and then the admission when they both occur on the same calendar date?

If the patient returned with the same condition, I recommend avoiding the discharge and admit codes. Instead, combine both levels of service in a subsequent visit code (99231-99233) based on the level of history, exam and medical decision-making.

If the patient had an entirely new condition that caused the new admit, then follow through with a whole new H&P work-up and bill the initial hospital visit code (99221-99223), as well as for discharge services earlier that day. Payers won’t be happy seeing a discharge and an admit on the same day, but if you submit the appropriate documentation showing that the patient needed to be admitted for a new diagnosis, you should avoid being hassled (or denied).

When to bill? Should hospitalists bill their portion of a hospitalization when we see the patient, or should we wait until the patient is discharged?

Either way works. Some groups hold billing until the hospital stay is completed, especially if patients stay a week or less. For longer hospitalizations, you may want to bill for services already completed so you don’t hold up the reimbursement process.

Hospitalist codes Is there a source that shows the most common codes that hospitalists use?

I haven’t seen any source document that specifically lists them. However, here are the CPT codes that, in my experience, hospitalist groups use most frequently:

• Initial hospital visits (99221-99223)
• Subsequent hospital visits (99231-99233)
• Discharge services (99238-99239)
• Critical care services (99291-99292)
• Inpatient consultations (for non-Medicare patients) (99251-99255)

Working with residents Say a patient is admitted at 10 p.m., when the resident team sees the patient, writes an H&P and does all the orders. I see the patient the next day, review the resident note and H&P, make corrections where appropriate, and independently (and personally) perform key portions of the H&P myself. Do I submit my charges as an initial visit on the day I see the patient, or use a subsequent visit code? I know I can’t bill for services on a day when I don’t see the patient, but I want to be reimbursed for the H&P I do.

Submit the H&P as an initial visit (99221-99223) on the day you see the patient under your name and number.

Consultations We often debate how to code for a consultation requested by a surgeon following a patient’s inpatient surgery. One of the physicians from our team performed the patient’s outpatient H&P medical clearance within seven days of the patient’s surgery.

We code that H&P with an outpatient consultation code (99241-99245) unless it’s a Medicare patient. For visiting the patient after the surgery, should we use inpatient consult codes (99251-99255) “unless it’s a Medicare patient, in which case we’d use subsequent visit codes? Or should we just use inpatient subsequent visit codes for all patients because we do have the H&P dictation available?

2021 readmission resources from CMS

To code visits after an inpatient surgery, use the subsequent visit codes (99231-99233), even for patients not covered by Medicare.

Using the -25 modifier I am writing about one of your replies in the March 2010 column ( “Uncompleted procedures? Here’s how to bill.” ). The question was how to bill for both critical care services and a subsequent visit on the same day for the same patient seen by two different physicians within the same group.

You claimed that the group should use the modifier -25 with the subsequent visit E/M service code to signal the fact that it was a separately identifiable service. However, that contradicts the AMA’s definition of modifier -25, which states the following:

“Significant, separately, identifiable evaluation and management service by the same physician on the same day of the procedure or other service. It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed.”

I have heard arguments for using the -25 modifier in both cases: for services provided by only one physician and also for multiple doctors within the same practice. And I understand how important it is to follow literal definitions.

However, the reimbursement process is a collision of three very different worlds. First, there’s the clinical world in which the practitioner is trying to offer the best care possible and document as such.

Second, there’s the coding world in which that documentation is filtered through an imperfect language of codes to represent what was done. Third, there’s the billing world in which each government and commercial payer and state can mandate various rules for how clinicians get paid.

Because both doctors in that original scenario are part of the same practice and use the same tax ID number, I’m fine sticking with my original answer. I’ve used the -25 modifier in just this situation for multiple physicians within a group, and I’ve never had any problems with those claims. You do need to use the modifier, though, to show the payer that there is a reason both services should be paid.

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The ins and outs of prolonged service ICD-9 codes

Here’s how to untangle the various categories of codes that come into play .

KENT J. MOORE

Fam Pract Manag. 2003;10(2):19-20

Family physicians must occasionally admit patients to the hospital from the office, emergency department (ED) or other sites of service. Coding admissions from these sites can be confusing. Here is what you need to know to do it correctly.

What CPT says

According to CPT, the initial hospital care codes, 99221–99223, are for “the first hospital inpatient encounter with the patient by the admitting physician.” Initial inpatient encounters by other physicians should be reported with either subsequent hospital care codes (99231–99233) or initial inpatient consultation codes (99251–99255), as appropriate.

CPT also offers the following guidance: “When the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (e.g., hospital emergency department, observation status in a hospital, physician’s office, nursing facility) all evaluation and management (E/M) services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission [emphasis added]. The inpatient care level of service reported by the admitting physicians should include the services related to the admission he/she provided in the other sites of service as well as in the inpatient setting.”

This same principle applies to the initial observation care codes, 99218–99220. Those codes are used to report “the encounter(s) by the supervising physician [emphasis added] when designated as ‘observation status.’” Observation encounters by other physicians should be coded using the office or other outpatient consultation codes, 99241–99245.

Also note that when a patient is admitted and discharged from either observation status or the hospital on the same date, CPT recommends that codes for same-day admission/discharge, 99234–99236, be used.

What Medicare and other payers say

Medicare requires that a patient be an inpatient or in observation status for a minimum of eight hours to report 99234–99236, but this is not a CPT requirement. Otherwise, Medicare policy and that of other payers generally follows the CPT guidelines with respect to hospital admissions and observation status.

For example, section 15505.1.A of the Medicare Carriers Manual states, in part, “When the patient is admitted to the hospital via another site of service (e.g., hospital emergency department, physician’s office, nursing facility), all services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.” Also, section 15505.1.F states, “Advise physicians to use the initial hospital care codes (codes 99221–99223) to report the first hospital inpatient encounter with the patient when he or she is the admitting physician.”

What it all means

The following scenarios may help you put the rules into practice:

• You see a patient in the hospital ED. During the course of that encounter, you admit the patient as an inpatient of the hospital. In this case, only an initial hospital care code, 99221–99223, should be submitted. Since the ED visit was related to the admission and occurred on the same date, you cannot separately code for that visit.

• You see a patient in your office. During the course of that encounter, you admit the patient to the hospital as an inpatient, but do not see the patient in the hospital that day. The next day, you visit the patient in the hospital for the first time. In this case, you would code an office visit (99201–99215) for services provided on the first day and an initial hospital care code (99221–99223) for services provided on the second day. Because you did not see the patient in the hospital the first day, you could not code 99221–99223 for that service since, as noted, these codes are for “the first hospital inpatient encounter with the patient by the admitting physician.” In this scenario, that encounter took place on the second day and is coded accordingly.

• You treat a patient in your office for an ear infection. That evening, you encounter the patient in the ED where she’s having severe asthma and admit her as an inpatient of the hospital. In this case, you could use an office visit code for the morning encounter and an initial hospital care code for the admission that evening. You would probably need to attach a -25 modifier (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the office visit code to indicate that it was unrelated to the subsequent admission. In this case, submitting different diagnosis codes would help further establish the appropriateness of coding both services.

• You see a patient in the ED. During the course of that encounter, you admit the patient to observation status at the hospital. Later that day, you determine that it is appropriate to discharge the patient to her home. In this case, you would use one of the codes for observation or inpatient care involving admission and discharge on the same date of service (i.e., 99234–99236); you would not separately code the ED visit.

It’s worth your time

Coding for hospital admissions from other sites of service can be confusing. However, since payers and CPT are generally playing by the same rules in this case, once you master the rules, appropriate reimbursement should follow.

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