2025 CPT code 99232
(Revised) Effective Date: N/A Revision Date: N/A Evaluation and Management - Hospital Inpatient and Observation Care Services Evaluation and Management Feed
Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
Modifiers can be applicable to this code to denote specific circumstances. For example, modifier 25 can be used to indicate a significant, separately identifiable E/M service on the same day as another service or procedure.
Medical necessity for 99232 is established by the patient’s condition requiring a subsequent hospital visit.The documentation should reflect the clinical rationale for the services provided.
The provider performs a follow-up evaluation and management (E/M) service for a patient already admitted to the hospital or under observation. The provider must spend at least 35 minutes or make moderate-level medical decisions. Time spent includes face-to-face and non-face-to-face activities like reviewing tests, preparing for the visit, counseling, ordering tests, communicating with other healthcare providers, documenting the encounter, interpreting results, and coordinating care.
In simple words: The provider sees a patient for a follow-up visit in the hospital or observation unit. The visit involves moderate medical decision-making or at least 35 minutes of the provider's time on that day.
Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient. This service includes a medically appropriate history and/or physical exam, along with a moderate level of medical decision making. Alternatively, the total time spent by the provider on the date of the encounter must be at least 35 minutes to qualify for this code.
Example 1: A patient admitted for pneumonia develops new shortness of breath. The physician spends 40 minutes evaluating the patient, reviewing lab results, and adjusting the treatment plan. This scenario justifies the use of 99232 based on time., A patient under observation for chest pain has an abnormal EKG. The physician spends 20 minutes evaluating the patient, interpreting the EKG, and consulting with a cardiologist to determine the next steps in management. This scenario justifies the use of 99232 based on medical decision making., A hospitalized patient with a chronic condition requires ongoing monitoring and management. The physician spends 35 minutes reviewing lab results, adjusting medications, and coordinating care with other specialists. This scenario also justifies the use of 99232 based on time.
Documentation should support the level of medical decision making or the total time spent.If using time, document the total time spent on the date of the encounter, including both direct and indirect time, and the activities performed. If using medical decision making, document the number and complexity of problems addressed, the amount and complexity of data reviewed, and the risk of complications.
- Specialties:Internal Medicine, Hospitalists, Surgeons, various specialties depending on the patient's condition.