99222 CPT Code

99222 CPT Code: A Complete Guide

The 99222 CPT code is one of the important ones in medical billing and reimbursement. It is a key code used to describe the hospital care of an inpatient patient on their first day of admission to inpatient hospital care or when placed into observation status. 99222 CPT: What is 99222? When to use the code? Coding and billing requirements and reimbursement.

What is CPT Code 99222?

CPT code 99222 is defined by the CPT code set as:

One initial hospital care per day for the evaluation and management of a patient, which requires these 3 key components:

  • A comprehensive history
  • A comprehensive examination
  • Medical decision making of moderate complexity

The use of this CPT code is to report the first hospital visit provided to a patient admitted as an inpatient to a hospital, or placed in an outpatient observation status, by a physician, or other qualified healthcare professional.

When is 99222 Used?

99222 Code: Initial hospital care is reported by the admitting physician or other qualified healthcare professional on the date the patient is admitted to inpatient or placed under observation. This initial hospital visit is inclusive of more elements than the other subsequent hospital visits.

Some key points about when to use 99222:

  • Used only for initial visit on admission date, not subsequent visits
  • For inpatient admissions or observation status
  • Cannot be used for emergency department services
  • Selection based on history, exam, and medical decision making documented

99222 Billing Guidelines and Requirements

There are specific documentation and billing requirements providers should understand when using 99222:

  • Admission date: 99222 is reported only for the initial visit on the admission date, not subsequent hospital visits.
  • History and exam: Must meet criteria for comprehensive history and comprehensive exam.
  • Medical decision making: Moderate complexity decision making is required. Time cannot be used for code selection.
  • One unit per admit: Only one unit of 99222 is billed per hospital admission or observation status. Cannot bill multiple units on admission date.
  • Principal diagnosis: The principal diagnosis supports the medical necessity of the admission.
  • Concurrent care: 99222 and critical care codes cannot be reported on the same date by the same provider.

99222 Reimbursement and Outlook

As with all CPT codes, reimbursement for 99222 varies by payer and geographic location. On average, Medicare reimbursement rates in 2022 are:

  • Average national Medicare rate: $236
  • Medicare rate in New Jersey: $265
  • Medicare rate in Idaho: $217

There may be influences on amounts of reimbursement from other factors like site of service, Modifier, and place of service, etc. Therefore, as the policies may be different from those of Medicare, it is recommended that providers check coverage and reimbursement policies with individual private payers.

There are no planned reductions to the RVUs for this code in the current Medicare Physician Fee Schedule. Nevertheless, this is subject to changes yearly, and providers will have to keep in the know.

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