Inpatient Admissions, 99222 and 99223

Do you really think caring for a patient in the hospital costs less than a patient out of the hospital? Apparently Insurance does.

It is the main reason why a decent amount of internal medicine doctors have relinquished their hospital care to doctors who are permanently in the hospital.....

Why should you get paid more for a complete physical with new problems than a patient who is septic and tachycardic?

Does it make any sense?

No.

Which is why I want to make sure you get paid what you should for your hospital care. I am going to cover 2 codes today.

If you have read my previous posts you will understand my philosophy.

1. Doctors often undercode for fear of audits, not because they did less work than they claim.
2. Doctor often think they are documenting properly, but are often wrong.
3. Thus doctors get audited and lose money for their services and the cycle perpetuates....

So with that in mind, let's take a systematic look at the hospital admission The codes 99222 and 99223 are what I will cover, because 99221 should probably not be admitted to the hospital.

Unless of course you have failed outpatient management with them.

99222 requires:
1. A Comprehensive History (See Here)
2. A Comprehensive Examination (See Here)
3. Medical Decision Making of Moderate Complexity

99223 requires:
Same as 99222 except this one key distinction.
Medical Decision Making of High Complexity......

What is the difference between Moderate and High? Not much really.
Try 1 Problem Point and 1 Data Point.

Huh? Ok, I guess if you said huh, you haven't read my other posts......

Medical Decision Making is Judged by 3 things. You need 2 of the 3 at the highest level you code for......

The things?
A. Problem Points. For each of the following things you document you receive points as below

New Problem with work up (4)

New problem no Work up (3)

Est Problem, Worsening (2)

Est Problem Stable(1)


What is the difference between Moderate and Complex? ONE point in this category plus ONE other point in Data, or classified as highest risk!


B. Data Points. For each of the following you document you also get points as below.


Labs Ordered OR Reviewed (1)

Indep Review of EKG/Film/Specimen (2)

Reviewed Old records (2)

Decision to Obtain Old Records(1)

Discuss test with Physician(1)

Order Test EKG/Cath/PFTs (1)


So in this case you need FOUR points to document High Risk, whereas you need 3 points for moderate.

The last item is titled Risk.

Risk is a nebulous little bugger which has been encapsulated in a table by EM University.

Personally I think it may be a little more complex than that, but the table is here for your viewing pleasure.

To meet the Risk criteria for a 99223 (The highest admission code) you need
High Risk

1. One or more chronic illness, with severe exacerbation or progression
2. Acute or chronic illness or injury, which poses a threat to life or bodily function
3. An abrupt change in neurological status
Or if you chose to do
1. Cardiovascular imaging, with contrast
2. Cardiac EP studies
3. Diagnostic endoscopies
4. Discography
5. Elective major surgery
6. Emergency major surgery
7. Parenteral controlled substances
8. Drug therapy requiring intensive monitoring for toxicity (Digoxin/Heparin)
9. Decision not to resuscitate, or to de-escalate care because of poor prognosis

I am certain there are more criteria than this, but I think you get my drift.
Most people you admit have one of 4 things.

1. Infection
2. Exacerbation of Chronic Disease
3. Chest Pain
4. Need Surgery

If you can claim that these conditions are severe, you can claim highest risk......
Or all you have to claim 4 points in Problems and 4 Points in Data.

Most doctors look at EKGs, Most doctors don't say independent review of EKG by me.... There is a huge difference to the insurers. The same is true for radiology studies......If you look at one film and look at one EKG, you have FOUR data points!!!!

That is enough to code at the highest level when you add 4 Problem points, which are probably the easiest to get. Now all you have to do is a comprehensive history and examination, which you better do when admitting a patient!

So In conclusion, most of your admissions will fall as 99223. Just look, take the time to document and get paid what you deserve!