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Medical Coding News Archives

AMA Releases Subsequent Observation E/M CPT Codes for 2011

 
December 6, 2010:

99224Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components:
  • Problem-focused interval history;
  • Problem-focused examination;
  • Medical decision making that is straightforward or of low complexity.
Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient’s hospital floor or unit.

99225Subsequent 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.
Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient’s hospital floor or unit.

99226Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components:
  • A detailed interval history;
  • A detailed examination;
  • Medical decision making of high complexity.
Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding [but?] unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient’s hospital floor or unit.

These codes are resequenced codes and do not appear in numeric order in the CPT manual. Resequenced codes are identified with the number (#) symbol. The AMA began the new numbering methodology of resequencing in 2010 as a way to create new codes within an existing group of codes when an unused code number is not available.

The subsequent observation codes are to be reported for physician services rendered while the patient is in observation status on days other than the date of admission (99218–99220), the date of discharge (99217), admission and discharge on the same date (99234–99236), or date of change from observation to inpatient admission (99221–99223). These codes should not be reported for routine post-procedural observation or recovery as those services are considered part of the surgical package.

Codes 99224–99226 include the review of the patient’s medical record and any diagnostic testing as well as an interval examination of the patient for the effectiveness of the medical treatment ordered and changes in status.

Previous to the implementation of these codes, subsequent observation E/M services were reported with 99499 (Unlisted evaluation and management service) as clarified in CPT Assistant, September 2006 pages 9–13.

 

 
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