CPT Code 99234: Inpatient or Observation Care, Same-Day Admit & Discharge, Low Complexity

CPT code 99234 is not used for emergency department (ED) visits; it is specifically for patients who are admitted to inpatient or observation status and discharged on the same date. For ED patients, appropriate ED visit codes (99281–99285) should be used unless the patient is admitted and discharged on the same day, in which case 99234–99236 may apply for the admission and discharge services.

Unlike time-based codes, 99234 is selected based on the complexity of medical decision making and documentation of admission, hospital care, and discharge services, all provided on the same date. While time spent is not the primary criterion, thorough documentation of the comprehensive assessment and management is required to support the code.

If a second provider evaluates the patient, they must document their own history, examination, and medical decision-making to bill separately. For Medicare patients, initial hospital care codes (99221–99223) should be used by the admitting physician, and consultations may not be separately billable. Coordination and appropriate modifiers may be needed depending on payer rules and whether the second provider’s services are distinct from the admitting provider’s care.

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