Inpatient Care: (all ages except initial newborn):
Inpatient Admission Level 1-3: 99221, 99222, 99223
Inpatient Subsequent (Rounding) Level 1-3: 99231, 99232, 99233
Discharge: Level 1 (<30 minutes) 99238
Discharge: Level 2 (>30 minutes) 99239
Critical Care Time:
For 24 months through adults:
Critical care: 30-74 minutes: 99291
Critical care: each additional 30 minutes after 75 minutes: 99292
Note: If you see the patient multiple times throughout the day, you need to document the patient interventions, time spent, and include the number of 99292 visits that correspond to the total time that day. If the time rolls over midnight, only contiguous time over and after midnight may be included in the prior day.
If less than 30 minutes, use a one time rounding code (99232 or 99233).
Neonates up to 28 days in NICU:
Initial visit: 99295
Subsequent visit: 99296
Infants 29 days to 24 months in PICU:
Initial visit: 99293
Subsequent visit: 99294
Emergency Room:
Level 1-5: 99281 (nurse), 99282, 99283, 99284, 99285
Critical Care codes instead, if applicable
Newborn:
Newborn Admission H&P: 99460
Newborn Subsequent Visits: 99462
Newborn Discharge: 99238
Newborn Same-Day Admission and Discharge: 99463 (e.g., if you complete the H&P the following calendar day after birth, and discharge later that day)
Newborn Circumcision: 54150
Newborn Frenulum incision (tongue-tie release): 41010
Newborn polydactyly or skin tag suture ligation (up to 15): 11200
Hospital and ED Procedures:
Thoracentesis with US Guidance: 32554
Paracentesis with US Guidance: 49083
Lumbar puncture: 62270
I&D: 10060 (single); 10061 (multiple)
Laceration Repair: 12001-12021
Women’s Health:
D&C Postpartum for retained products: 59160
D&C Diagnostic/Therapeutic: 58120
D&C for Incomplete SAB, any age: 59812
D&C for Missed SAB <14 WGA: 59820
D&E for Missed SAB >14 WGA to 20 WGA: 59821
After 20 WGA: Use delivery codes
OB: See below.
Most intensive care or emergency department procedures will be included within the context of time-based critical care or high level emergency department codes, and will not be separately billable. If not included there, and you perform these personally, you may bill these separately:
● NG or OG tube (Gastric intubation): 43752
● Endotracheal intubation: 31500
● Ventilator management: Can’t be billed separately with any other E/M inpatient codes, critical care codes, or ED codes
● Arterial catheters (Art line): 36620; if cut-down procedure: 36625
● Central venous catheters (Central lines)
○ Patients <5 years, non tunneled: 36555 and tunneled 36557
○ Patients 5 and older, non-tunneled: 36556 and tunneled 36558
○ Removing central line: 36589
Nursing Home/SNF:
● Initial Admit, Level 1-3: 99304-99306
● Subsequent Visits, Level 1-4: 99307-99310
● Discharge: 99315 (<30 minutes); 99316 (>30 minute)
○ If Pt deceased, you may only bill discharge, if physician personally performed the death pronouncement.
OB:
OB Global billing codes below include 13 to 15 routine antepartum office visits, labor and delivery management, routine postpartum hospital care, and 1 routine postpartum office visit. Coding is determined by route of delivery. Anesthesia may bill separately. Labs and Ultrasound bill separately. Vaginal delivery includes episiotomy, 1st and 2nd degree laceration repair, vacuum/forceps.
o Vaginal delivery (+/- forceps/vacuum): 59400
o C-section delivery: 59510
o Vaginal delivery after prior C-section (VBAC): 59610
o C-section delivery after prior C-section: 59618
● If the above “full bundle” is not provided, “piecemeal” OB billing is provided:
o SVD (+/- forceps/vacuum) including inpatient postpartum care: 59409
o SVD (+/- forceps/vacuum) and both inpatient/outpatient postpartum care: 59410
o VBAC (+/- forceps/vacuum) including inpatient postpartum care: 59612
o VBAC (+/- forceps/vacuum) and both inpatient/outpatient postpartum care: 59614
o C-section including inpatient postpartum care: 59514
o C-section and both inpatient/outpatient postpartum care: 59515
o C-section after TOLAC including inpatient postpartum care: 59620
o C-section after TOLAC and both inpatient/outpatient postpartum care: 59622
o Outpatient prenatal or postpartum care only, see outpatient document
o No discharge codes, since this is part of the SVD or C/S code