What is the CPT code 99217?

Observation Care Discharge Day Management CPT Code 99217 is used to report all services provided to a patient discharged from outpatient hospital “observation status” if the discharge is on a date other than the initial date of “observation status”.

An initial observation care Current Procedural Terminology (CPT) code, 99218-99220, on the first date, when the patient is in observation status. … You cannot report the observation care discharge service code, 99217, in conjunction with a hospital admission.

A: Assign the appropriate same day observation code (99234-99236) for combined ED/Observation services. Do not assign 99217. (Note that there is no 8 hour threshold for CPT observation services.) For a Medicare patient with 6 hours of Observation time, codes 99218-99220 would be used.

For patients in observation more than 48 hours, the physician of record would bill an initial observation care code (99218–99220), a subsequent observation care code for the appropriate number of days (99224–99226) and the observation discharge code (99217), as long as the discharge occurs on a separate calendar day.

If a physician observation visit (procedure code 99217, 99218, 99219, 99220, 99234, 99235, or 99236) is billed by the same provider with the same date of service as prolonged services (procedure code 99354, 99355, 99356, or 99357), the prolonged services will be denied as part of another procedure on the same day.

Scenario 1: Telehealth Visit practitioner cannot use CPT codes 99202-99205. These codes are used only when audio and video are used for the visit. Instead, use CPT codes 99441-99443 with Modifier CR.

Right and Left Facing Triangle symbols are used to indicate that changes in text have been made other than the procedure descriptors. A Plus symbol denotes an add-on code, which is an additional or supplementary procedure in addition to the primary procedure being performed.

You can bill the discharge management code only once per hospital stay, on the day of the actual discharge. You cannot bill for a subsequent hospital visit on that day, in addition to the discharge code.

CPT® 99225 is the middle (level 2) subsequent observation care code in this family of codes that also includes CPT® codes 99224 and 99226. All three codes are part of the Healthcare Common Procedure Coding System (HCPCS). Observation care is considered outpatient care.

If you ask another physician to see your patient during his or her observation stay, that physician should use office or outpatient visit codes 99201-99215 or outpatient consult codes 99241-99245.

It is the intent to allow a physician more time to evaluate or treat a patient and make a decision to admit or discharge. Observation status generally lasts 24 to 48 hours.

CPT® Code 99226 – Subsequent Hospital Observation Care Services – Codify by AAPC. CIC (Certified Inpatient Coder) NEW! CRC (Certified Risk Adjustment Coder) NEW! CDEO (Certified Documentation Expert – Outpatient) NEW!

If a patient was in observation, then use POS 22. But if the patient was actually admitted and discharged on the same day, then go with POS 21.

Revenue Code 762 – Observation Services – Must be billed with corresponding CPT Codes 99218, 99219, 99220, 99234, 99235 or 99236.

Medicare has an 8-hour minimum for physicians reporting the observation same-day-discharge codes 99234-99236. This 8-hour minimum does not apply to an observation stay that spans 2-calendar days (99217-99220).

CPT® 99219, Under New or Established Patient Initial Hospital Observation Care Services. The Current Procedural Terminology (CPT®) code 99219 as maintained by American Medical Association, is a medical procedural code under the range – New or Established Patient Initial Hospital Observation Care Services.

Coding conventions require the condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a “code first” note with the manifestation code and a “use additional code” note with the etiology code in ICD-10.

Observation services are hospital outpatient services you get while your doctor decides whether to admit you as an inpatient or discharge you. You can get observation services in the emergency department or another area of the hospital.

Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. Audio-only encounters can be provided using the telephone evaluation and management codes (CPT codes 99441-99443).

For these E-Visits, the patient must generate the initial inquiry and communications can occur over a 7-day period. The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. The patient must verbally consent to receive virtual check-in services.

We’ve found that most payers advise providers billing telemedicine to use the appropriate evaluative and management CPT code (99201 – 05, 99211-15) along with a GT or 95 modifier (more on that below).

• Triangle ( ▲ ) Identifies revised code descriptions.
• Bullet ( ● ) Identifies new procedures and services added to CPT.
• Horizontal Triangles ( ▶◀ ) Surround revised guidelines and notes.
• Plus ( ✚ ) Identifies add-on codes.
• Forbidden ( Ø ) …
• Bull’s-eye ( ◉ ) …
• Flash ( ϟ ) …
• Circle ( O )

CPT Symbol: Telemedicine; may be reported for synchronous telemedicine services.

CPT Category III codes are a set of temporary (T) codes assigned to emerging technologies, services, and procedures. These codes are intended to be used for data collection to substantiate more widespread usage or to provide documentation for the Food and Drug Administration (FDA) approval process.

An external cause of injury code or E-code is used when a patient presents to a healthcare provider with an injury. … E-codes essentially capture the “who, what, where, why, and how” surrounding an injury event.

Subsequent inpatient care – E&M codes (99231, 99232, 99233) used to report subsequent hospital visits. Hospital Discharge Day Management Services – E&M codes (99238, 99239) used to report the work performed to discharge a patient from an inpatient stay.

CPT code 99233 is assigned to a level 3 hospital subsequent care (follow up) note. 99233 is the highest level of non-critical care daily progress note.

99225 Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity.

Would it be appropriate to bill a higher-level established outpatient code, such as a 99213 or 99214, using medical-necessity criteria? A: According to Medicare guidelines, only the physician or group that admits a patient to observation can use observation codes.

99241 CPT Code: Office consultation for a new or established patient that requires these three key components: a problem-focused history; a problem-focused examination; and straightforward medical decision-making.

CPT® 99222, Under New or Established Patient Initial Hospital Inpatient Care Services. The Current Procedural Terminology (CPT®) code 99222 as maintained by American Medical Association, is a medical procedural code under the range – New or Established Patient Initial Hospital Inpatient Care Services.

The Two-Midnight rule, adopted in October 2013 by the Centers for Medicare and Medicaid Services, states that more highly reimbursed inpatient payment is appropriate if care is expected to last at least two midnights; otherwise, observation stays should be used.

Condition Code 44–Inpatient admission changed to outpatient – For use on outpatient claims only, when the physician ordered inpatient services, but upon internal review performed before the claim was initially submitted, the hospital determined the services did not meet its inpatient criteria.

The three days must be consecutive. They include the day you’re admitted but not the day you’re discharged because one “day” counts only if you’re in the hospital at midnight. Nor do they include any time you spend in the emergency room.

Place of Service Code(s)Place of Service Name11Office12Home13Assisted Living Facility14Group Home *

I think it would be POS 11 even if it is owned by the hospital it is offsite and in an office. 22 POS to me is when a service is performed in the hospital and the patient is never admitted.

Beginning January 1, 2016, POS code 22 was redefined as “On-Campus Outpatient Hospital” and a new POS code 19 was developed and defined as “Off-Campus Outpatient Hospital.” Effective January 1, 2016, POS 19 must be used on professional claims submitted for services furnished to patients registered as hospital …