Medical Coding

Category - Evaluation and Management

A patient is admitted to the telemetry unit for observation for chest pain, directly from his physician’s office. The hospitalist spent a little more than 50 minutes on the unit after the patient arrived, performing a comprehensive examination and obtaining a comprehensive history on the patient. The hospitalist performed moderate complexity medical decision making when ordering labs, telemetry, stress testing and echocardiogram. What is the appropriate code for initial observation care of this patient?
  1. 99218
  2. 99219
  3. 99220
  4. 99224
Explanation
Answer: B - 99219 is the correct code for an initial observation care requiring moderate complexity medical decision making.
Code 99218 is incorrect because this observation patient required more than low complexity or straightforward medical care. Code 99220 is incorrect because the hospitalist did not spend enough time on the unit with this patient initially and this patient did not require high complexity medical decision making. Code 99224 is incorrect because this code is for subsequent observation care and not the initial care.
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