2023 Observation Care Discharge Services
(99217 has been deleted. To report observation care discharge
services, see 99238, 99239)
Initial Observation Care
New or Established Patient
(99218, 99219, 99220 have been deleted. To report initial observation
care, new or established patient, see 99221, 99222, 99223)
Subsequent Observation Care
(99224, 99225, 99226 have been deleted. To report subsequent
observation care, see 99231, 99232, 99233)
Hospital Inpatient and Observation
Care Services
The following codes are used to report initial and subsequent evaluation and management
services provided to hospital inpatients and to patients designated as hospital outpatient
"observation status." Hospital inpatient or observation care codes are also used to report partial
hospitalization services.
For patients designated/admitted as “observation status” in a hospital, it is not necessary that the
patient be located in an observation area designated by the hospital. If such an area does exist in
a hospital (as a separate unit in the hospital, in the emergency department, etc), these codes may
be utilized if the patient is placed in such an area.
For a patient admitted and discharged from hospital inpatient or observation status on the same
date, report 99234, 99235, 99236, as appropriate.
Total time on the date of the encounter is by calendar date. When using MDM or total time for
code selection, a continuous service that spans the transition of two calendar dates is a single
service and is reported on one calendar date. If the service is continuous before and through
midnight, all the time may be applied to the reported date of the service.
Initial Hospital Inpatient or Observation Care
New or Established Patient
The following codes are used to report the first hospital inpatient or observation status
encounter with the patient.
An initial service may be reported when the patient has not received any professional services
from the physician or other qualified health care professional or another physician or other
qualified health care professional of the exact same specialty and subspecialty who belongs to
the same group practice during the stay. When advanced practice nurses and physician assistants
are working with physicians, they are considered as working in the exact same specialty and
subspecialty as the physician.
For admission services for the neonate (28 days of age or younger) requiring intensive
observation, frequent interventions, and other intensive care services, see 99477.
When the patient is admitted to the hospital as an inpatient or to observation status in the
course of an encounter in another site of service (eg, hospital emergency department, office,
nursing facility), the services in the initial site may be separately reported. Modifier 25 may be
added to the other evaluation and management service to indicate a significant, separately
identifiable service by the same physician or other qualified health care professional was
performed on the same date.
In the case when the services in a separate site are reported and the initial inpatient or
observation care service is a consultation service, do not report 99221, 99222, 99223, 99252,
99253, 99254, 99255. The consultant reports the subsequent hospital inpatient or observation
care codes 99231, 99232, 99233 for the second service on the same date.
If a consultation is performed in anticipation of, or related to, an admission by another physician
or other qualified health care professional, and then the same consultant performs an encounter
once the patient is admitted by the other physician or other qualified health care professional,
report the consultant’s inpatient encounter with the appropriate subsequent care code (99231,
99232, 99233). This instruction applies whether the consultation occurred on the date of the
admission or a date previous to the admission. It also applies for consultations reported with any
appropriate code (eg, office or other outpatient visit or office or other outpatient consultation).
For a patient admitted and discharged from hospital inpatient or observation status on the same
date, report 99234, 99235, 99236, as appropriate.
For the purpose of reporting an initial hospital inpatient or observation care service, a transition
from observation level to inpatient does not constitute a new stay.
Hospital Inpatient or Observation Care
Services (Including Admission and Discharge
Services)
The following codes are used to report hospital inpatient or observation care services provided
to patients admitted and discharged on the same date of service.
For patients admitted to hospital inpatient or observation care and discharged on a different date,
see 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239.
Codes 99234, 99235, 99236 require two or more encounters on the same date of which one of
these encounters is an initial admission encounter and another encounter being a discharge
encounter. For a patient admitted and discharged at the same encounter (ie, one encounter), see
99221, 99222, 99223. Do not report 99238, 99239 in conjunction with 99221, 99222, 99223 for
admission and discharge services performed on the same date.
(For discharge services provided to newborns admitted and discharged
on the same date, use 99463)
Hospital Inpatient or Observation Discharge
Services
The hospital inpatient or observation discharge day management codes are to be used to report
the total duration of time on the date of the encounter spent by a physician or other qualified
health care professional for final hospital or observation discharge of a patient, even if the time
spent by the physician or other qualified health care professional on that date is not continuous.
The codes include, as appropriate, final examination of the patient, discussion of the hospital
stay, instructions for continuing care to all relevant caregivers, and preparation of discharge
records, prescriptions, and referral forms. These codes are to be utilized to report all services
provided to a patient on the date of discharge, if other than the initial date of inpatient or
observation status. For a patient admitted and discharged from hospital inpatient or observation
status on the same date, report 99234, 99235, 99236, as appropriate.
Codes 99238, 99239 are to be used by the physician or other qualified health care professional
who is responsible for discharge services. Services by other physicians or other qualified health
care professionals that may include instructions to the patient and/or family/caregiver and
coordination of post-discharge services may be reported with 99231, 99232, 99233.
Office or Other Outpatient Consultations
New or Established Patient
The following codes may be used to report consultations that are provided in the office or
other outpatient site, including the home or residence, or emergency department. Follow-up
visits in the consultant’s office or other outpatient facility that are initiated by the consultant or
patient are reported using the appropriate codes for established patients in the office (99212,
99213, 99214, 99215) or home or residence (99347, 99348, 99349, 99350). Services that
constitute transfer of care (ie, are provided for the management of the patient’s entire care or for
the care of a specific condition or problem) are reported with the appropriate new or established
patient codes for office or other outpatient visits or home or residence services.
(For an outpatient consultation requiring prolonged services, use
99417)
(99241 has been deleted. To report, use 99242)
Inpatient or Observation Consultations
New or Established Patient
Codes 99252, 99253, 99254, 99255 are used to report physician or other qualified health care
professional consultations provided to hospital inpatients, observation-level patients, residents of
nursing facilities, or patients in a partial hospital setting, and when the patient has not received
any face-to-face professional services from the physician or other qualified health care
professional or another physician or other qualified health care professional of the exact same
specialty and subspecialty who belongs to the same group practice during the stay. When
advanced practice nurses and physician assistants are working with physicians, they are
considered as working in the exact same specialty and subspecialty as the physician. Only one
consultation may be reported by a consultant per admission. Subsequent consultation services
during the same admission are reported using subsequent inpatient or observation hospital care
codes (99231-99233) or subsequent nursing facility care codes (99307-99310).
(For an inpatient or observation consultation requiring prolonged
services, use 993X0)
(99251 has been deleted. To report, use 99252)
