99221-99223 Initial hospital care codes
These are the "initial hospital care" codes used by family physicians for coding their admission history and physical services for hospitalized patients. The global codes (59400, 59510, 59610, 59618) do not include initial or subsequent hospital services by the physician if the patient does not deliver. Physicians should code admissions (in-patient or out-patient) for false labor, out-patient PG gel, stress tests or medical/surgical complications separately. Initial hospital care services are not separately reported if the patient delivers within 24 hours of admission and the physician charges for the delivery or global package.
The criteria used for utilizing these codes with a maternity care patient are absolutely no different than with any other patient; however, a physician cannot use these codes in conjunction with the global codes, as the global codes already include initial hospital care for the patient who delivers.
Using Other Evaluation and Management Services in Maternity Care
Hospital Services
Prolonged Physician Services
| 99356 | Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour |
| (List separately in addition to code for inpatient evaluation and management service.) | |
| 99357 | Each additional 30 minutes |
| (List separately in addition to code for prolonged physician service.) |
These codes are key to the family physician for the non-routine and non-critical (but complicated) maternity care patient who is either transferred to another facility, requires cesarean delivery, or is delivered by another provider. These specific CPT codes describe the prolonged but non-"critical care" services provided by a physician to a complicated maternity patient after the admission history and physical.
CPT states that code 99356 is for the first hour of prolonged physician attendance on a given date. One may also use it to report a total duration of prolonged service of 30 to 60 minutes on a given date. However, a physician should use it only once per date, even if the time spent by the physician is not continuous on that date. Prolonged service of less than 30 minutes total duration on a given date is not separately reported because the work involved is included in the total work of the initial evaluation and management code.
Code 99357 is for each additional 30 minutes beyond the first hour and the final 15-30 minutes of prolonged service on a given date. Prolonged service of less than 15 minutes beyond the final 30 minutes is not reported separately.
The following table illustrates the reporting requirements for prolonged physician service for inpatients, with direct (face-to-face) patient contact:
CPT states that code 99356 is for the first hour of prolonged physician attendance on a given date. One may also use it to report a total duration of prolonged service of 30 to 60 minutes on a given date. However, a physician should use it only once per date, even if the time spent by the physician is not continuous on that date. Prolonged service of less than 30 minutes total duration on a given date is not separately reported because the work involved is included in the total work of the initial evaluation and management code.
Code 99357 is for each additional 30 minutes beyond the first hour and the final 15-30 minutes of prolonged service on a given date. Prolonged service of less than 15 minutes beyond the final 30 minutes is not reported separately.
The following table illustrates the reporting requirements for prolonged physician service for inpatients, with direct (face-to-face) patient contact:
| Total Duration of Prolonged Services | Code(s) |
|---|---|
| Less than 30 minutes (less than 1/2 hour) |
Not reported separately |
| 30-74 minutes (1/2 hr. - 1 hr. 14 min.) |
99356 X 1 |
| 75-104 minutes (1 hr. 15 min. - 1 hr. 44 min.) |
99356 X 1 AND 99357 x 1 |
| 105-134 minutes (1 hr. 45 min. - 2 hr. 14 min.) |
99356 X 1 AND 99357 X 2 |
| 135-164 minutes (2 hr. 15 min. - 2 hr. 44 min.) |
99356 X 1 AND 99357 X 3 |
| 165-194 minutes (2 hr. 45 min. - 3 hr. 14 min.) |
99356 X 1 AND 99357 X 4 |
| 99358 | Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (e.g., review of extensive records and tests, communication with other professionals and/or patient/family); first hour |
| (List separately in addition to code(s) for other physician service(s) and/or inpatient or outpatient evaluation and management service.) | |
| 99359 | Each additional 30 minutes |
| (List separately in addition to code for prolonged physician service.) |
Codes 99358 and 99359 are for those situations when a physician provides prolonged service that does not involve direct (face-to-face) care. A physician should use codes 99358 and 99359 to report the total duration of non-face-to-face time spent by a physician on a given date providing prolonged service, even if the time spent by the physician on that date is not continuous.
Code 99358 is for the first hour of prolonged service on a given date. A physician may also use it to report a total duration of prolonged service of 30 to 60 minutes on a given date. The physician should use this code only once per date even if the time spent by the physician is not continuous on that date. Prolonged service of less than 30 minutes total duration on a given date is not separately reported.
Code 99359 is for each additional 30 minutes beyond the first hour. It is also for the final 15 to 30 minutes of prolonged service on a given date. Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately.
The table used for prolonged face-to-face services, used in the above section, can be adapted for non-face-to-face prolonged physician service time also:
Code 99358 is for the first hour of prolonged service on a given date. A physician may also use it to report a total duration of prolonged service of 30 to 60 minutes on a given date. The physician should use this code only once per date even if the time spent by the physician is not continuous on that date. Prolonged service of less than 30 minutes total duration on a given date is not separately reported.
Code 99359 is for each additional 30 minutes beyond the first hour. It is also for the final 15 to 30 minutes of prolonged service on a given date. Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately.
The table used for prolonged face-to-face services, used in the above section, can be adapted for non-face-to-face prolonged physician service time also:
| Total Duration of Non-Face-to-Face Prolonged Services | Code(s) |
|---|---|
| Less than 30 minutes (less than 1/2 hour) |
Not reported separately |
| 30-74 minutes (1/2 hr. - 1 hr. 14 min.) |
99358 X 1 |
| 75-104 minutes (1 hr. 15 min. - 1 hr. 44 min.) |
99358 X 1 AND 99359 x 1 |
| 105-134 minutes (1 hr. 45 min. - 2 hr. 14 min.) |
99358 X 1 AND 99359 X 2 |
| 135-164 minutes (2 hr. 15 min. - 2 hr. 44 min.) |
99358 X 1 AND 99359 X 3 |
| 165-194 minutes (2 hr. 45 min. - 3 hr. 14 min.) |
99358 X 1 AND 99359 X 4 |
The AAFP and American College of Obstetricians and Gynecologists worked diligently with the American Medical Association to create and implement these codes. However, not all carriers may cover these services. Of course, physicians should back up the utilization of these codes with appropriate documentation in the medical chart that supports the services provided, the start time and the stop time of each service, and the medical necessity of the service. Physicians may need to use documentation techniques on their charts or progress notes in ways similar to attorneys who often charge professional services by time increments.
Critical Care
| 99291 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes |
| 99292 | Each additional thirty minutes |
| (List separately in addition to code for the primary service.) |
Occasionally, family physicians use critical care services when caring for maternity care patients who undergo critical medical complications of pregnancy (e.g., eclampsia, myocardial infarct, abruptio placenta, placenta previa, post-partal hemorrhage, pulmonary embolus, etc.). Critical care includes the care of critically ill or critically injured patients in a variety of medical emergencies (e.g., cardiac arrest, shock, bleeding, respiratory failure, postoperative complications). Critical care is usually, but not always, given in a critical care area, such as the coronary care unit, intensive care unit, respiratory care unit, or the emergency care facility. In most hospitals, the maternity care unit is also considered a potential critical care area.
Like the prolonged services codes, the critical care codes are time dependent. They are used to report the total duration of time spent by a physician providing critical care services to a critically ill or critically injured patient. Physicians should use code 99291 to report the first 30 to 74 minutes of critical care on a given date, and they should use it only once per date, even if the time spent is not continuous. Physicians should use code 99292 to report each additional 30 minutes beyond the first 74 minutes.
For example, if a physician provides one hour of critical care at 10 a.m. and 2 hours from 3 p.m. to 5 p.m., then the physician should report code 99291 once and 99292 four times to report the total of three hours on a single day.
The following services are included in reporting critical care when performed during the critical period by the physician providing critical care and cannot be reported separately: the interpretation of cardiac output measurements (93561, 93562), chest X-rays (71010, 71015, 71020), pulse oximetry (94760, 94761, 94762), blood gases, and information data stored in computers (e.g., ECG's, blood pressures, hematologic data (99090)); gastric intubation (43752, 91105); temporary transcutaneous pacing (92953); ventilatory management (94002-94004, 94660, 94662); and vascular access procedures (36000, 36410, 36415, 36591, 36600).
Procedures that are not directly related to critical care management are not included in critical care and should be reported separately. Once the critical care situation is over, then the family physician can use the prolonged services codes to code any additional time needed for prolonged physician attendance.
Like the prolonged services codes, the critical care codes are time dependent. They are used to report the total duration of time spent by a physician providing critical care services to a critically ill or critically injured patient. Physicians should use code 99291 to report the first 30 to 74 minutes of critical care on a given date, and they should use it only once per date, even if the time spent is not continuous. Physicians should use code 99292 to report each additional 30 minutes beyond the first 74 minutes.
For example, if a physician provides one hour of critical care at 10 a.m. and 2 hours from 3 p.m. to 5 p.m., then the physician should report code 99291 once and 99292 four times to report the total of three hours on a single day.
The following services are included in reporting critical care when performed during the critical period by the physician providing critical care and cannot be reported separately: the interpretation of cardiac output measurements (93561, 93562), chest X-rays (71010, 71015, 71020), pulse oximetry (94760, 94761, 94762), blood gases, and information data stored in computers (e.g., ECG's, blood pressures, hematologic data (99090)); gastric intubation (43752, 91105); temporary transcutaneous pacing (92953); ventilatory management (94002-94004, 94660, 94662); and vascular access procedures (36000, 36410, 36415, 36591, 36600).
Procedures that are not directly related to critical care management are not included in critical care and should be reported separately. Once the critical care situation is over, then the family physician can use the prolonged services codes to code any additional time needed for prolonged physician attendance.
Attendance at Delivery and Other Newborn Care
As a family physician, even when not providing delivery services, you may be asked to be available to provide care for the newborn. For information on codes for standby, attendance at delivery, or newborn resuscitation services, please see Attendance at Delivery and Stabilization. For information on reporting care provided to newborns beyond initial stabilization, please see Coding Newborn Care Services.
