These codes are used to report initial hospital care services (otherwise known as admission H&Ps). These codes are used for both inpatients and observation care patients. There are three levels of care for these services. There is significant variability in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the patient to optimize reimbursement.
For these encounters, the level of care may be selected based on the MDM required for the visit OR based on time spent.
The rules for performing and documenting initial hospital care services are covered extensively in the INITITAL HOSPITAL CARE course, which includes examples for all three levels of care as well as detailed explanations of the MDM and time required for each visit.
The 99221 level of care for initial hospital care services (otherwise known as a level 1 admission H&P) is the lowest level of care for these encounters. This level of care requires straightforward or low complexity medical decision-making or a total of forty minutes of time spent.
The 99221 level of care is used for about 4.4% of initial hospital care services among internists and pays about $75.
The 99222 level of care for initial hospital care services (otherwise known as a level 2 admission H&P) requires moderate complexity medical decision-making or a total of fifty-five minutes of time spent.
The 99222 level of care is used for about 22.3% of initial hospital care services among internists and pays about $117.
The 99223 level of care for initial hospital care services (otherwise known as a level 3 admission H&P) is the highest level of care for these encounters. This level of care requires high complexity medical decision-making or a total of seventy-five minutes of time spent.
The99223 level of care is used for about 73.3% of initial hospital care services among internists and pays about $156.
The rules for performing and documenting initial hospital care services are covered extensively in the INITITAL HOSPITAL CARE course, which includes examples for all three levels of care as well as detailed explanations of the MDM and time required for each visit.