Physician education is cornerstone to Zotec’s mission, which is to improve the business of healthcare for everyone. Here, we educate radiologists on the nuances of the 2023 inpatient evaluation and management (EM) changes.
Effective on date of service January 1, 2023, the inpatient EM coding guidelines have been updated. These updates mirror the EM guideline changes implemented in 2021 for office and outpatient EM services.
Hospital Inpatient and Observation Care Services – EM Code Changes
Initial hospital care codes 99221-99233 will represent both inpatient and observation services
| Service Provided | DOS Prior to 2023 | DOS 2023 and Forward |
| Observation Care Discharge Services | 99217 | 99238 (< 30 minutes) or 99239 (> 30 minutes) Does not include admission and discharge on the same date |
| Initial Observation Care | 99218, 99218, 99220 | 99221, 99222, 99223 |
| Subsequent Observation Care | 99224, 99225, 99226 | 99231, 99232, 99233 Depending on MDM or time associated with visit |
Determining the EM Level of Service
Hospital inpatient or observation codes will be reported based on Medical Decision Making (MDM) or time
Reporting by Time
Reporting using time is now associated with a threshold which the documented time must meet or exceed to report the level of service
The table below represents the required time(s) in minutes to meet or exceed per level of service
| EM Service Description | Time in Minutes |
| 99221 – Initial care | 40 |
| 99222 – Initial care | 55 |
| 99223 – Initial care | 75 |
| 99231 – Subsequent care | 25 |
| 99232 – Subsequent care | 35 |
| 99233 – Subsequent care | 50 |
| 99234 – Same day initial/discharge | 45 |
| 99235 – Same day initial/discharge | 70 |
| 99236 – Same day initial/discharge | 85 |
Reporting by Medical Decision Making (MDM)
Reporting using MDM requires documentation to meet or exceed the same level in at least 2 of the following categories
Please reference 2023 Inpatient EM Changes – Documentation Tip Sheet for recommendations and examples.
References
CPT® Professional Edition 2023
AMA® CPT Symposium 2022
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