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Thread: Initial Hospital Care

  1. #1
    Join Date
    Apr 2007

    Default Initial Hospital Care

    AAPC: Back to School
    Any suggestions or thoughts on the correct code for an initial hospital encounter with an EPF history, EPF exam and MDM of high complexity?
    99221, the lowest level of initial hospital care requires a detailed history, detailed exam and MDM if low complexity.

    Jenny Berkshire, CPC-GI, E/M

  2. #2
    Join Date
    Apr 2007


    How much time was utilized??

  3. #3
    Join Date
    Apr 2007


    Time was not documented. I read some previous posts that suggest the subsequent hospital visit codes (99231-99233) be used.

  4. #4


    yes, this is still a gray area for me too. i cant find any definitive documentation on this. some people state to use an unlisted code while others downcode to a subsequent visit.

    i'm curious too!!

  5. #5

    Default Initial Hospital Care

    Hi j.berkshire,

    I am looking in the AMA CPT 2008 E/M Pocket Reference Guide and found this paragraph:

    "A critical guideline of this code series indicates that codes 99221-99223 are reported for the first hospital inpatient encounter with the patient by the admitting physician. This date may not be the same as the date the patient was admitted to the hospital"

    I would think that code 99223 for what you described.

    Just my $.02 worth.

    Pedenia Y. Evans, CPC

  6. #6


    Was this patient seen at another site before being admitted to the hospital, such as the physician's office? If so, that service could be included in determining your inpatient hospital care code. If not, I believe you would only be able to charge the lowest level.

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