Wiki Cpt 99231,99232, 99233

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CPT® Codes 99231, 99232, 99233

Codes 99231, 99232, and 99233 are used for the evaluation and management (E/M) of a patient, when a physician sees the patient in the hospital on an inpatient basis (follow up visit). These codes are based on the documentation and the guidelines for two out of the three key components and medical necessity that must be met to reach a level:

• To bill a 99231, be sure you meet two of the three components: problem-focused history, problem-focused exam, and straight forward or low medical decision-making (MDM); or based on time 15 minutes.
• To bill a 99232, be sure you meet two of the three components: expanded problem-focused history, expanded problem-focused exam, and moderate MDM; or based on time 25 minutes.
• To bill a 99233, be sure you meet two of the three components: a detailed history, detailed exam, and high MDM; or based on time 35 minutes.

The key point is the provider must document history, exam, and MDM and two out of those three must meet or exceed a level.

If the physician is billing based on time, there must be the correct time statement documented.

Remember: 99231-99233 are inpatient codes. If the patient is in observation status and not admitted to inpatient status, use outpatient consult codes (check your payer) or typical office visits such as 99201-99205 and 99211-99215. To help avoid denials and audits, be very observant of the codes you use when the patient is in different facilities.

Here is a good resource from the Centers for Medicare & Medicaid Services to better explain E/M service leveling: Evaluation and Management Services.

ErickCA65

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I am not sure I understand the CPT 99231, 99232, 99233. Can anyone to explain to me about that? Give me example.
 

purplescarf23

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These are used when the physician see's patients on an inpatient basis(follow up visits). To bill a 99231 you need 2 of the 3 components: Problem Focused History, Problem Focused Exam or Straight Forward or Low MDM, or based on time 15 minutes, 99232 you need again 2 of the 3 components: Expanded Problem Focused History, Expanded Problem Focused Exam, Moderate MDM, or based on time 25 minutes, and lastly 99233 requires a Detailed History, Detailed Exam, High MDM or based on time 35 minutes. If billing on time must have the correct time statement documented. Hope this helps.

Kelsey, CPC, CEMC
 
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To bill 99231, 99232 and 99233

To add information, when the physician see an inpatient, and is stable, recovering or improving use the 99231 code. When the physician see an inpatient in subsequence visit the patient respond to inadequately treatment or develop a minor complication bill 99232 for this date of services. When the patient develop a new problem or significant complication or ustable use the 99233.

Mayra I. Santiago, MA
 

mitchellde

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Not really. It is based on the documentation and the guidelines as Kelsey stated 2 out of the 3 key components must be met to be a level. The key point is the provider must document History exam and decision making and tow out of those 3 must meet or exceed a level. It is not based on if the patient is stable or improving.
 
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Not really. It is based on the documentation and the guidelines as Kelsey stated 2 out of the 3 key components must be met to be a level. The key point is the provider must document History exam and decision making and tow out of those 3 must meet or exceed a level. It is not based on if the patient is stable or improving.
OK. First, is the use of the component based the evaluation and management usually present the patient and the provider document about medical decision making.

Mayra I. Santiago
 

rthames052006

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Debra is correct-

Those scenario's are used as examples only, it's not a must.

In the CPT book under each level of service they give you a "guide" but the visit will be based on 2 of the 3 key components and medical necessity.

They also try to give you some "time" estimates as well for the codes, like for 99233 they state " physicians usually spend 35 minuets at the bedside and on the patients facility floor or unit" but that is not always going to happen. Just use those things as a guide, not gospel.
 

mray85

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Can we bill procedure 99233 with Place of service 22.
No, place of service 22 is Out-patient. 99231 99232 99233 are In-patient codes. If the patient is in Observation status and not admitted to In-patient status, you can use Outpatient consult codes (check your payer) or typical office visits such as 99201-99205 and 99211-99215. Be very observant of the codes you are assigning when the patient is in different facilities - using wrong codes will lead to denials and audits.
 
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I've been using modifier 24 when using this code series. I'm wondering if modifier 77 would be more accurate. Please advise....
 
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