tci Medicare Compliance & Reimbursement - 2022 Issue Q2

Reader Questions: Use This Insight to Pick the Correct Inpatient Codes

Question: We are revisiting our coding policies and wondered about choosing the right E/M codes for inpatient care. Do we use the same criteria as we do for choosing outpatient E/M services? Louisiana Subscriber Answer: No. Even though the Centers for Medicare & Medicaid Services (CMS) made significant strides in updating outpatient evaluation and management (E/M) codes in 2021, those changes didn’t translate to inpatient E/M codes. Reminder: The inpatient care codes 99221-99223/99231- 99233 (Initial/Subsequent hospital care, per day, for the evaluation and management of a patient …) and 99234-99236 (Observation or inpatient hospital care, for the...

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