CPT Code 99233

CPT Code 99233 for Subsequent Hospital Care

Code 99233 would be one of the important codes a provider would need to be aware of when billing for inpatient hospital care. It contains the subsequent hospital care code with the highest level for an admitted patient.

Some key things to know about CPT code 99233:

  • Used for subsequent inpatient hospital visit
  • Highest level of care for hospital progress note
  • Requires detailed interval history and high complexity MDM
  • 35 minutes of face-to-face time with patient

What Does CPT 99233 Cover?

CPT code 99233 is a subsequent inpatient hospital visit provided to an admitted patient. This code can be billed if during the course of care the following occurred:

  • Subsequent hospital care
  • Hospital observation services
  • Hospital swing bed services

This code covers the physician’s visit to the patient in the hospital after the initial hospital care code (99221-99223) has already been used.

Key Requirements for Billing 99233

To report CPT 99233, the following 3 key requirements must be met:

  • Detailed interval history – Review of system intervals since last visit
  • High complexity medical decision making – Assessing data to make decisions about patient’s care
  • 35 minutes of face-to-face time – With the patient, family, or bedside caregiver

All 3 criteria must be documented in the progress note to justify billing 99233.

How It Differs from 99232

CPT code 99232 is for a level 2 subsequent hospital care visit. Here is how it differs from 99233:

  • Time: 99232 requires 25 minutes. 99233 requires 35 minutes.
  • History: 99232 requires an expanded problem focused interval history. 99233 requires a detailed interval history.
  • MDM: 99232 requires moderate complexity MDM. 99233 requires high complexity MDM.

So 99233 represents a higher level of care.

Diagnosis Codes Commonly Reported with 99233

Common diagnoses when reporting subsequent hospital care CPT code 99233 include:

  • Heart failure (I50.23)
  • Pneumonia (J18.9)
  • COPD exacerbation (J44.1)
  • Sepsis (A41.9)
  • Acute respiratory failure (J96.00)

Documentation should link the appropriate diagnosis code to support medical necessity.

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