2025 CPT code 99233
(Revised) Effective Date: N/A Revision Date: N/A Evaluation and Management - Hospital Inpatient and Observation Care Services 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 high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.
Modifiers may be applicable.Modifier 25 may be appended if a significant, separately identifiable E/M service is provided by the same physician on the same day as the procedure or other service.Modifier -FS can be used in split/shared visits.
Medical necessity must be clearly documented and should justify the level of service provided. The documentation should indicate why a subsequent hospital visit of this intensity was necessary.
The physician is responsible for evaluating and managing the patient's condition during a subsequent hospital visit, which requires at least 50 minutes of total time spent or a high level of medical decision making.
In simple words: This code is used for a follow-up visit with a patient who is already staying in the hospital or is under observation. The doctor spends at least 50 minutes with the patient or makes complex medical decisions about the patient's care.
This code represents subsequent hospital inpatient or observation care provided to a patient on a given day. It includes a medically appropriate history and/or examination, along with a high level of medical decision making (MDM).If using total time on the date of the encounter for code selection, a minimum of 50 minutes must be spent by the provider.This time includes both face-to-face and non-face-to-face time spent by the physician on the day of the encounter. Non-face-to-face time can include reviewing test results, communicating with other healthcare providers, and documenting the encounter.For encounters lasting 65 minutes or more, prolonged service code 99418 should be used in addition to 99233.
Example 1: A patient admitted for heart failure develops worsening renal function. The physician spends 55 minutes evaluating the patient, reviewing labs, adjusting medications, and consulting with a nephrologist. This scenario justifies the use of 99233 due to the high MDM involved., A patient is hospitalized with pneumonia and experiences respiratory distress. The physician spends one hour stabilizing the patient, ordering and interpreting tests, and adjusting the treatment plan, meeting the high MDM requirement of this code., A post-surgical patient develops a wound infection. The physician evaluates the patient, orders cultures and antibiotics, consults with infectious disease, and documents the complicated course. The extensive time and MDM justify using 99233.
Documentation must support the level of MDM or the total time spent.Detailed documentation should include the patient's condition, complexity of the medical decision making (number and complexity of problems, amount and complexity of data reviewed, risk of complications), and the total time spent on the date of the encounter. If based on time, the documentation must clearly outline how the time was spent (e.g., reviewing tests, discussing the case with other providers, counseling the patient or family).
** The documentation should reflect the complexity of the patient’s condition, the risk involved, and the decision making required. Remember to use iFrameAI for more up to date information regarding Medical Codes.
- RVU: 2.0 wRVU
- Specialties:Hospitalists, Intensivists, various specialists managing hospitalized patients
- Place of Service:Inpatient Hospital