• My Account
    • Login
  • Contact Us

CodingIntel

Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

  • Join Today
  • What is CodingIntel
    • About
    • Become a Member
    • FAQ
  • Pricing
  • Free Resources
    • Overview
    • Blog
    • Everyday Coding Q&A
    • Newsletter
    • Can I get paid
  • Coding Library
    • Coding Guides
    • Quick Reference Sheets
    • E/M Services
    • How Physician Services Are Paid
    • Prevention & Screening
    • Care Management & Remote Monitoring
    • Surgery, Modifiers & Global
    • Diagnosis Coding
    • New & Newsworthy
    • Speciality
    • Practice Management
    • E/M Rules Archive
  • Webinars

March 25, 2023

Coding for observation services

CPT codes for observation services

Beginning January 1, 2023 there are two sets of codes used for both inpatient status and observation level of care. Coding for observation services no longer has a distinct set of CPT® codes, those were deleted. Use 99221–99223 for initial inpatient or observation care services and use 99231–99233 for inpatient or observation subsequent visits. 99238 and 99239 are the discharge codes.

For admission and discharge on the same calendar date, use codes 99234—99236.

Medicare says, “Only the attending physician of record reports the discharge day management service.”

Place of service

Continue to report the correct place of service on the claim form, place of service 21 for inpatient hospital and place of service 22 for on campus—outpatient hospital. Observation is an outpatient service.

Consulting physicians

Following CPT® rules, a consulting physician would report inpatient consult codes 99252—99255 for the initial service. These are now defined as inpatient or observation services.  Use 99231—99233 for follow up visits. For patients with commercial insurance that still recognizes consultation codes, this is the correct coding for observation services.

Coding for observation services for Medicare patients seen in consultation

Medicare stopped recognizing consultation codes in 2010. Chapter 12 of Medicare’s Claims Processing Manual has not changed its instruction with the deletion of observation codes 99218—99220, 99224-99226, and 99217.  Their manual says “Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient’s observation services began. All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes.”

  • For all payers, the admitting physician uses 99221-99223 for patients in observation level of care.
  • For commercial payers that recognize consults, the consulting physician uses 99252—99255 for patients in observation level of care.
  • For Medicare patients, the consulting physician uses office and/or other outpatient codes 99202—99215. Keep in mind the definition of new patient. A new patient is a patient who has never been seen by that physician or their same specialty partner (in their group) for the past three years. Use these codes for the initial visit and subsequent visits.

CMS citations: Medicare Claims Processing Manual, Ch. 12, Section 30.6. 9 and 30.6.10

Want unlimited access to CodingIntel's online library?

Including updates on CPT® and CMS coding changes for 2023

Join Today

Last revised March 14, 2023 - Betsy Nicoletti
Tags: hospital inpatient/observation

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

2023 E/M reference sheets

These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. And, a bonus sheet with typical time for those code sets. Sign up for Betsy’s monthly newsletter to download these reference sheets and share them with your practitioners.

Sign Up Now

2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

Watch it now

Latest Intel

Coding for hospital services | Webinar

Coding for hospital services April 20, 2023 … Read More...

CMS Split/Shared Services Rules | Reference Sheet

Download Reference Sheet Split/shared services … Read More...

Chronic Care Management | Reference Sheet

This quick reference sheet includes clinical staff … Read More...

Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse | HCPCS Code G0442

The  US Preventive Services Task Force (USPSTF) … Read More...

Browse By Categories

Browse Content

  • Articles
  • Coding Guides
  • Everyday Coding Q&A
  • Videos
  • Can I Get Paid to
  • Blog
  • Webinars

Tags

behavioral health_cpt codes behavioral health_E/M services care management CMS updates Code sets and reimbursement compliance issues CPT codes for preventive services CPT updates critical care services dermatology_essential resource dermatology_procedures E/M frequency data E/M medical decision making E/M overview E/M reference sheets FQHC general surgery_diagnosis coding general surgery_E/M services general surgery_modifiers general surgery_procedures global surgery issues HCC diagnosis coding hospital inpatient/observation ICD-10 coding level of service_history level of service_MDM level of service_time medicare incident-to and shared services minor procedures modifiers newborn care office and other E/M Preventive and problem visits preventive services for medicare primary care_diagnosis coding primary care_E/M services primary care_essential resource primary care_modifiers primary care_other E/M services primary care_preventive services primary care_procedures remote physiologic monitoring screening and counseling for behavioral conditions teaching physician rules telehealth

All content on CodingIntel is copyright protected. Any resource shared within the permissions granted here may not be altered in any way, and should retain all copyright information and logos.

  • What is CodingIntel
  • FAQs
  • Terms of Use
  • Privacy Policy
  • Contact

Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

Copyright © 2023, CodingIntel
Privacy Policy