Wiki inpatient E&Ms initial vs subsequent

[NEOSM507]

I need help understanding the proper use of inpatient evaluation and management codes. Are initial inpatient codes (99221-99223) for the initial evaluation of a problem and subsequent codes (99231-99233) for follow up visits for the same problem?
For example:
patient is inpatient, and seen by an ortho for cellulitis on Oct 1. We bill 99221
patient is seen Oct 2 follow up by same ortho Oct 2. We bill 99231

same patient is back in the hospital inpatient, and ortho sees them for lumbar sprain on Nov 1. Does the ortho bill an initial inpatient code because its a new problem? Or do they report a subsequent code because they're an existing patient and it hasn't been 3 years since they were seen.

I hope that made sense.

Thank you!

 

[katemae84]

The use of Initial vs Subsequent Inpatient codes is based on whether the provider has seen the patient during that current hospital admission, not based on whether the problem is new or the New vs Established patient rules used in Office/Outpatient settings. So using your example from above:
Yes, if October 1 is the first time Ortho is seeing the patient during the hospitalization, then you'll use 9922x for the Initial Inpatient care, and 9923x for the Subsequent Inpatient care on October 2.
The November 1 visit will either be another Initial Inpatient code (if the patient was discharged in between Ortho's last visit on Oct 2 and this Nov 1 visit) or a Subsequent Inpatient care code (if the patient has been Inpatient the whole time and not discharged between Oct 2 and Nov 1).