2025 CPT code 99222
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Initial Hospital Inpatient or Observation Care Evaluation and Management Feed
Initial hospital inpatient or observation care; moderate medical decision-making or at least 55 minutes of total time.
Modifier -25 may be added if a significant, separately identifiable E/M service was performed by the same physician on the same date.
Medical necessity for this code is established when the patient's condition requires an initial hospital inpatient or observation care visit involving a moderate level of medical decision-making or at least 55 minutes of total time for evaluation and management.
The physician performs a comprehensive assessment of the patient's condition, develops a treatment plan, and coordinates care with other healthcare professionals.
- Evaluation and Management
- Evaluation and Management > Hospital Inpatient and Observation Care Services > Initial Hospital Inpatient or Observation Care
In simple words: This code is used when a doctor first sees a patient in the hospital (either as an inpatient or in observation).The doctor spends at least 55 minutes with the patient or makes moderately complex medical decisions about the patient's care.
This CPT code reports the initial hospital inpatient or observation care visit for a patient requiring evaluation and management (E/M) services.The service includes a medically appropriate history and/or examination, and involves a moderate level of medical decision-making (MDM) or a total time of at least 55 minutes on the date of the encounter.Total time includes both face-to-face and non-face-to-face activities such as reviewing tests, preparing for the visit, performing the exam, counseling, ordering tests, communicating with other providers, documenting the encounter, interpreting results, and coordinating care.MDM considers the number and complexity of problems, the amount and complexity of data reviewed, and the risk of complications.
Example 1: A 65-year-old male presents to the emergency department with chest pain and shortness of breath. After stabilization, he is admitted to the hospital. The admitting physician performs a comprehensive history and physical examination, orders various tests, and makes a moderate level of medical decisions regarding the patient's treatment. The total time spent on the patient on the admission date exceeds 55 minutes., A 28-year-old female is admitted for a planned cesarean section.The anesthesiologist conducts a pre-operative evaluation, assessing the patient's medical history and performing a focused physical examination.The anesthesiologist also orders relevant tests and consults with other specialists. The time spent on the day of admission for the patient exceeds 55 minutes., A 70-year-old with a history of heart failure presents to the hospital with worsening dyspnea. The attending physician completes a comprehensive evaluation that includes a detailed history, physical exam, orders numerous tests, and communicates with other specialists, leading to a moderate level of medical decision-making and a total time of 60 minutes.
Detailed documentation of the history, physical examination, medical decision-making, and total time spent on the patient should be recorded in the medical record to support the use of this code.This should include the chief complaint, history of present illness, review of systems, past, family, and social history, as well as details of the physical examination and medical decision-making process.
** This code is used for the initial hospital visit. Subsequent visits should be billed using codes 99231-99233.For patients admitted and discharged on the same day, use codes 99234-99236.
- Payment Status: Active
- Specialties:All specialties
- Place of Service:Inpatient Hospital, Observation