CPT Code 99222

What is the CPT Code 99222

This code reports the comprehensive initial hospital care provided by healthcare professionals, and healthcare providers use this code to bill for the evaluation and management services performed during the first encounter with a patient admitted to the hospital.

Healthcare professionals, medical coders, and billing professionals must understand the details and guidelines associated with CPT code 99222. This article will give you an overview of CPT 99222 and learn about the description, critical components, billing guidelines, modifiers, examples, and frequently asked questions about 99222.

Contents show

What is the CPT Code 99222

Overview of CPT code 99222:

What are the Key Components of an Evaluation and Management Service for Reporting 99222?

1. History:

2. Examination

3. Medical-decision-making:

4. Time of encounter:

What are the billing guidelines for 99222?

What modifiers can we append to 99222?

1. Modifier 24:

2. Modifier 25:

3. Modifier 57:

4. Modifier AI:

5. Telehealth modifiers:

Summary:

Frequently Asked Questions (FAQs)

What does CPT 99222 report?

What is the total time of encounter for CPT 99222?

What modifiers can we append to CPT 99222?

Overview of CPT code 99222:

This code reports the initial hospital in-patient or observation care for evaluating or managing a new or established patient. The evaluation and management require a medically appropriate history and examination with a moderate level of decision-making. The total time of the encounter must be 55 minutes or more for 99222.

The initial hospital care includes the patient’s admission to the hospital as an in-patient during an encounter in another site of service, including the hospital emergency department, and all the healthcare provider’s evaluation and management services. The physician reports initial care when the patient has yet to receive any professional services from the physician or other qualified healthcare professional of the same specialty or subspecialty of the same group practice.

The in-patient care level includes the physician’s services in other service sites and the in-patient setting.

What are the Key Components of an Evaluation and Management Service for Reporting 99222?

To report the CPT 99222, the healthcare provider must consider all the critical components of an Evaluation and Management E&M service.

The following are the critical components of evaluation and management:

1. History:

To report 99222, the healthcare provider must take a detailed history at a comprehensive level. The process of history-taking includes:

• A Chief Complaint

A chief complaint is the reason for which the patient seeks medical attention. It is a statement from the patient about the problem, condition, symptom, diagnosis, or physician-recommended return.

• History of Present illness (HPI)

The history of the present illness will include the symptoms, location, quality, severity, duration, context, modifying factors, and associated signs or symptoms. The 99222 reports an extended history of the present illness. Extended history taking includes reporting four or more elements mentioned above.

• Past, Family, and Social History (PFSH)

The healthcare provider also obtains the history of past injuries, illnesses, operations, medications, and treatments. Getting information about the patient’s family history (hereditary diseases) and social history (environment, lifestyle, past and current activities) help prepare an effective treatment plan. 99222 reports a complete PFSH (3 history areas for all new patients and two history areas for all follow-up established patients).

2. Examination

A thorough examination is a compulsory part of initial hospital care. CPT 99222 requires a comprehensive physical examination that can be a general, multisystem exam, or full exam

The comprehensive examination also includes a review of systems (ROS).

Review of systems:

Reviewing body systems and questions about signs and symptoms help diagnose the condition better. The healthcare provider can review the following systems:

1. Constitutional ( fever, blood pressure, weight loss, etc.)
2. Neurologic system
3. Ears, nose, mouth, throat
4. Eyes
5. Respiratory system
6. Cardiovascular system
7. Gastrointentestinal system
8. Musculoskeletal system
9. Integumentary system
10. Genitourinary system
11. Psychiatric systems
12. Endocrine system
13. Lymphatic system
14. Immune system

3. Medical-decision-making:

CPT 99222 requires medical decision-making of moderate complexity. Meeting two or more of the following criterion decides the moderate level for 99222:

• Multiple management options
• Review of a moderate amount of data, including lab results, diagnostic imaging results, and other practitioner’s notes
• Moderate risk of complications, morbidity, and mortality along with comorbidities

4. Time of encounter:

The total time of encounter must be 50-69 minutes to report CPT 99222.

What are the billing guidelines for 99222?

Following are some of the billing guidelines for 99222:

• The healthcare provider can only present the place of service as IH because 99222 only bills in-patient services.
• The healthcare provider must mention the same-day discharge while reporting 99222. In this case, the coder must bill the assessment meeting with different evaluation and management codes, as billing initial in-patient and discharge codes separately is not allowed.
• The 99222 reports only one service by the same physician or specialty per day.
• Code the claim separately if the healthcare provider requests a consultation from a different specialty.
• The healthcare providers should report the encounters as initial evaluation and management services because most commercial insurances do not accept consultation codes.
• If the healthcare provider shares the service during a visit, they might get a split share by an NPP, and the service is billed under their NPI. These visits are only acceptable under the supervision of the resident treating physician with their signature. The document must have two separate portions of the NPP and treating physician.

What modifiers can we append to 99222?

We can append only a limited number of modifiers with 99222. Following are the modifiers that are allowed with 99222 if needed:

1. Modifier 24:

The healthcare provider will report modifier 24 with 99222 if the patient receives initial in-patient E&M service in the global period (from 10-90 days, depending on the complexity of the procedure) of any previous major or minor surgery.

2. Modifier 25:

The healthcare provider will report modifier 25 with 99222 if he performs a separately identifiable service (EKG monitoring, TB testing, etc.) on the day of the encounter. Appending modifier 25 will make the particular evaluation and management service eligible for reimbursement; otherwise, the insurance company may consider the service included in the encounter.

3. Modifier 57:

The healthcare provider will report modifier 57 with 99222 if they decide to perform surgery on the initial encounter for evaluation and management. They will also report it for a day before any minor and major surgery in the global surgical package because the insurance companies might not reimburse it separately.

4. Modifier AI:

When the admitting physician requests the provider from any other specialty for consultation, modifier AI will append.

5. Telehealth modifiers:

When the physician provides a telehealth visit, they will append modifiers like GT and 95 to CPT 99222.

Examples of CPT 99222:

Following are some simple examples for a better understanding of billing CPT 99222:

1. A 56-year-old female patient is admitted to the hospital for wheezing sounds of breath and chest pain. The healthcare provider conducts a comprehensive evaluation, performs a detailed physical examination, reviews the patient’s medical history, and orders simple diagnostic tests to determine the cause of the pain and abnormal sound.

CPT Code: 99222- Comprehensive Initial Hospital Care

Modifiers: None

Diagnosis Codes: R07.9- Chest pain, unspecified

2. A 72-year-old male patient with multiple chronic conditions, including COPD and heart failure, is admitted to the hospital. The attending pulmonologist assesses the patient’s respiratory status, evaluates the effectiveness of current treatments, and makes recommendations for managing COPD exacerbation during the hospital stay.

CPT Code: 99222- Comprehensive Initial Hospital Care

Modifiers: None

Diagnosis Codes: 150.9- Heart failure, unspecified; J44.1- Chronic Obstructive Pulmonary Disease with (acute) exacerbation

3. A 55 year old female patient is admitted to the hospital with a foot ulcer that has become infected. The patient has a history of diabetes and hypertension. The physician performs a comprehensive assessment, including a detailed wound examination, evaluates the patient’s overall medical condition, and formulates a treatment plan.

CPT Code: 99222- Comprehensive Initial Hospital Care

Modifiers: None

Diagnosis Codes: E11.621- Type 2 Diabetes mellitus with foot ulcer; I10- Essential (primary) hypertension

Summary:

Description: Initial hospital care

History: Detailed

History of present illness (HPI): Extended (four elements)

Review of systems (ROS): Extended (2-9 systems)

Past, family, and social history (PFSH): Complete (2-3)

Examination: Comprehensive ( a general, multisystem exam, areas of organ systems)

Medical decision-making: Moderate Complexity

Frequently Asked Questions (FAQs)

See Also

20610 CPT Code

CPT Code 96372

CPT Code 93306

CPT Code 99204

CPT Code 99203