observation care evaluation and management codes - Oxford Health ...

CPT ®Code99219992209922499225992269923499235Descriptionqualified healthcare professionals, or agencies are provided consistent with the natureof the problem(s) and the patient's and/or family's needs. Usually, the problem(s)requiring admission to "observation status" are of low severity. Typically 30 minutes arespent at the bedside and on the patient's hospital floor or unit.Initial observation care, per day, for the evaluation and management of a patient, whichrequires these 3 key components: A comprehensive history; A comprehensiveexamination; and Medical decision making of moderate complexity. Counseling and/orcoordination of care with other physicians, other qualified healthcare professionals, oragencies are provided consistent with the nature of the problem(s) and the patient'sand/or family's needs. Usually, the problem(s) requiring admission to "observationstatus" are of moderate severity. Typically 50 minutes are spent at the bedside and onthe patient's hospital floor or unit.Initial observation care, per day, for the evaluation and management of a patient, whichrequires these 3 key components: A comprehensive history; A comprehensiveexamination; and Medical decision making of high complexity. Counseling and/orcoordination of care with other physicians, other qualified healthcare professionals, oragencies are provided consistent with the nature of the problem(s) and the patient'sand/or family's needs. Usually, the problem(s) requiring admission to "observationstatus" are of high severity. Typically 70 minutes are spent at the bedside and on thepatient's hospital floor or unit.Subsequent observation care, per day, for the evaluation and management of a patient,which requires at least 2 of these 3 key components: Problem focused interval history;Problem focused examination; Medical decision making that is straightforward or of lowcomplexity. Counseling and/or coordination of care with other physicians, other qualifiedhealthcare professionals, or agencies are provided consistent with the nature of theproblem(s) and the patient's and/or family's needs. Usually, the patient is stable,recovering, or improving. Typically 15 minutes are spent at the bedside and on thepatient's hospital floor or unit.Subsequent observation care, per day, for the evaluation and management of a patient,which requires at least 2 of these 3 key components: An expanded problem focusedinterval history; An expanded problem focused examination; Medical decision making ofmoderate complexity. Counseling and/or coordination of care with other physicians,other qualified healthcare professionals or agencies are provided consistent with thenature of the problem(s) and the patient's and/or family's needs. Usually, the patient isresponding inadequately to therapy or has developed a minor complication. Typically 25minutes are spent at the bedside and on the patient's hospital floor or unit.Subsequent observation care, per day, for the evaluation and management of a patient,which requires at least 2 of these 3 key components: A detailed interval history; Adetailed examination; Medical decision making of high complexity. Counseling and/orcoordination of care with other physicians, other qualified healthcare professionals oragencies are provided consistent with the nature of the problem(s) and the patient'sand/or family's needs. Usually, the patient is unstable or has developed a significantcomplication or a significant new problem. Typically 35 minutes are spent at the bedsideand on the patient's hospital floor or unit.Observation or inpatient hospital care, for the evaluation and management of a patientincluding admission and discharge on the same date which requires these three keycomponents: a detailed or comprehensive history; a detailed or comprehensiveexamination; and medical decision making that is straightforward or of low complexity.Counseling and/or coordination of care with other physicians, other qualified healthcareprofessionals or agencies are provided consistent with the nature of the problem(s) andthe patient's and/or family's needs. Usually the presenting problem(s) requiringadmission are of low severity. Typically, 40 minutes are spent at the bedside and on thepatient’s hospital floor or unit.Observation or inpatient hospital care, for the evaluation and management of a patientincluding admission and discharge on the same date which requires these three keyObservation Care and Evaluation and Management Codes: Reimbursement Policy (Effective 04/01/2013)©1996-2013, Oxford Health Plans, LLC4