99222 Initial hospital visit Medicare reimbursement rates in Kentucky

This service is the first hospital evaluation by a physician or qualified practitioner during an inpatient admission or observation stay. A hospitalist or admitting physician may assess a patient hospitalized for pneumonia, a COPD exacerbation, or worsening heart failure; a specialist may also use the initial hospital care family for a first evaluation during the stay. The diagnosis alone does not establish the level. The clinician’s assessment, review of available records and results, treatment decisions, and communication with other clinicians help establish the work performed.

Select 99222 for moderate medical decision making (MDM) or at least 55 minutes of the billing practitioner’s total time on the encounter date. Document the problems addressed, data considered, and management risk when selecting by MDM, or document total time when selecting by time. An initial hospital care service is generally reported once per admission by a physician or practitioners of the same specialty in the same group. For Medicare, the principal physician of record identifies the admission service with modifier AI; other physicians reporting initial hospital care omit it. If admission and discharge occur on the same date, Medicare uses a combined service code when the stay lasts at least eight hours.