3 Helpful Hints for Better Subsequent Hospital Care E/M Coding


Excellent article by Deborah Marsh at SuperCoder


Subsequent hospital care E/M codes 99231-99233 have some oddities that can trip you up if you don’t use these codes often (and even if you do). Improve your E/M coding accuracy by keeping these three pointers in mind.

1. Look for 2 of 3 With Interval History Option

The descriptors for 99231, 99232, and 99233 all specify that the code requires you to meet two of three key components required. The key components are interval history, examination, and medical decision making, with levels required varying by code.

Did you catch the “interval” terminology in “interval history”? That means the history needs to cover the history of the illness since the last assessment, such as changes in physical condition and response to management.

CMS states that for an interval history, you don’t need to record PFSH (past, family, and/or social history) information. To read this rule in print, see page 8 of the MLN Evaluation and Management Services document.

2. Don’t Try to Get Around the ‘Per Day’ Rule

Accurate coding of subsequent hospital care E/M requires you to respect the “per day” part of the descriptor. That means the code and payment represent all E/M services by the physician for the patient on that date. Review Medicare Claims Processing Manual (MCPM), chapter 12, section 30.6.9.B, for Medicare’s official wording.

For accurate coding and payment, make sure you factor in all the E/M services during that date when you select the code. If a physician is covering for another physician who saw the patient earlier in the day, the MCPM says contractors should not pay the second physician separately because of the “per day” rule (section 30.6.9.C).

Opportunity: Medicare contractors should pay multiple physicians separately if each is in a different specialty, is responsible for a different aspect of the patient’s care, and bills with a distinct diagnosis (that’s also in section 30.6.9.C of MCPM chapter 12).

3. Use ‘Subsequent’ Code for First Service Sometimes

Because Medicare does not recognize consultation codes for Part B payment, you report those services using the E/M code specific to the site and complexity of the visit. The problem is that consult services don’t always meet the strict requirements for initial hospital care codes. To get around this issue, Medicare instructs MACs to accept subsequent hospital care codes even for a provider’s first E/M service for an inpatient if the subsequent care code best represents the service rendered. To get Medicare’s wording on that topic, check MCPM, chapter 12, section 30.6.10.

Have questions? I’m here to help.