Wiki Inpatient billing

[vnazaire1]

Good day all,

I received a letter that E/M codes 99234-99236 were billed for an inpatient stay that was greater than 24 hrs. The patient was seen at the hospital for the same provider for 3 days. How should I proceed?

Thanks for any help

 

[sls314]

Good day all,

I received a letter that E/M codes 99234-99236 were billed for an inpatient stay that was greater than 24 hrs. The patient was seen at the hospital for the same provider for 3 days. How should I proceed?

Thanks for any help

99234-99236 are used when the patient is admitted and discharged on the same date of service. That's why they would be denied for a stay longer than 24 hours.

The codes in the range 99221-99233 are what you're looking for. The coder* should review the CPT descriptions and choose the correct code(s) that match the service rendered and documented.

* I was unclear whether you're the coder since you asked about inpatient billing specifically.

 

[vnazaire1]

99234-99236 are used when the patient is admitted and discharged on the same date of service. That's why they would be denied for a stay longer than 24 hours.

The codes in the range 99221-99233 are what you're looking for. The coder* should review the CPT descriptions and choose the correct code(s) that match the service rendered and documented.

* I was unclear whether you're the coder since you asked about inpatient billing specifically.

Thanks !! I am just the coder but because I am the only certified coder in my billing department I am being trained for billing. My follow up question is If its the same provider that has consulted for date 3/4/25 and 3/5/25 can I bill in the range 99221 - 99233 range for both dates of service or can I bill 99234 for day 1 and use the range for the second day?

 

[sls314]

Thanks !! I am just the coder but because I am the only certified coder in my billing department I am being trained for billing. My follow up question is If its the same provider that has consulted for date 3/4/25 and 3/5/25 can I bill in the range 99221 - 99233 range for both dates of service or can I bill 99234 for day 1 and use the range for the second day?

If the patient was in the hospital for 3 days, 99234 would not be appropriate for any visit that occurred during this stay.

Do you have access to a CPT book? I would encourage you to review the section for Hospital Inpatient and Observation services. In the 2025 CPT book, that would be pages 21-24.

This chart in the CPT book will be particularly helpful for what codes you can bill based on the patient's length of stay:

 

[sls314]

This blog post from AAPC may also help: https://www.aapc.com/blog/86922-coding-inpatient-and-observation-visits-in-2023/

(2023 was the year the new CPT guidelines went into effect for inpatient and observation services.)

I'm sure there are likely YouTube videos that might help too - look for a specific one about Hospital Inpatient and Observation E/M since 2023. I'll try to find one when I get a chance, but I'm on my way out the door shortly.