Hospital Medicine, coding reference.

Use for the documented initial inpatient or observation service when the applicable straightforward or low criteria are met, or when at least 40 minutes of qualifying time are documented. Select the level from the actual encounter, not a diagnosis, medication, bed location or typical billing pattern. A prescription-management decision contributes to risk; it does not establish the overall MDM level by itself.

Use for the documented initial inpatient or observation service when at least two of the three MDM elements at moderate complexity are met, or when at least 55 minutes of qualifying time are documented. Select the level from the actual encounter, not a diagnosis, medication, bed location or typical billing pattern. A prescription-management decision contributes to risk; it does not establish the overall MDM level by itself.

Use for qualifying initial inpatient or observation care when at least two of three MDM elements meet high complexity, or at least 75 minutes of qualifying total time are documented. A high-risk decision alone does not establish the overall MDM level. For Medicare prolonged services with a time-selected 99223, the first G0316 unit requires 90 minutes under the CMS counting rules.

Use for the documented subsequent inpatient or observation service when the applicable straightforward or low criteria are met, or when at least 25 minutes of qualifying time are documented. Select the level from the actual encounter, not a diagnosis, medication, bed location or typical billing pattern. A prescription-management decision contributes to risk; it does not establish the overall MDM level by itself.

Use for the documented subsequent inpatient or observation service when at least two of the three MDM elements at moderate complexity are met, or when at least 35 minutes of qualifying time are documented. Select the level from the actual encounter, not a diagnosis, medication, bed location or typical billing pattern. A prescription-management decision contributes to risk; it does not establish the overall MDM level by itself.

Use for the documented subsequent inpatient or observation service when at least two of the three MDM elements at high complexity are met, or when at least 50 minutes of qualifying time are documented. Select the level from the actual encounter, not a diagnosis, medication, bed location or typical billing pattern. A prescription-management decision contributes to risk; it does not establish the overall MDM level by itself.

For the practitioner responsible for discharge when a separate discharge-day service is reportable. Select by actual qualifying discharge-management time, 30 minutes or less, rather than the number of diagnoses, medications or discharge destination.

For the practitioner responsible for discharge when a separate discharge-day service is reportable. Select by actual qualifying discharge-management time, more than 30 minutes, rather than the number of diagnoses, medications or discharge destination.

Use when the illness threatens vital organ function and the practitioner actually delivers qualifying critical care. ICU location alone is insufficient. At least 30 qualifying minutes are required; shorter services use the appropriate E/M family for the actual setting and encounter.

For Medicare, report the first 99292 only after 104 total qualifying minutes, the second at 134 minutes, and subsequent units after each complete additional 30 minutes. For example, 150 qualifying minutes supports 99291 plus two units of 99292. Exclude separately billed procedures, overlapping time, and activities that do not meet critical-care requirements. Other payers may apply different rules.

Use for an eligible same-calendar-date admission and discharge with separate admission and discharge encounters. Select straightforward or low MDM using at least two of the three MDM elements, or the documented time threshold. A diagnosis, prescription change or risk element alone does not establish the level.

Use for an eligible same-calendar-date admission and discharge with separate admission and discharge encounters. Select moderate MDM using at least two of the three MDM elements, or the documented time threshold. A diagnosis, prescription change or risk element alone does not establish the level.

Use for an eligible same-calendar-date admission and discharge with separate admission and discharge encounters. Select high MDM using at least two of the three MDM elements, or the documented time threshold. A diagnosis, prescription change or risk element alone does not establish the level.

Use only when the payer recognizes consultation codes and the consultation requirements are met. A diagnosis alone does not determine the level.

Use only when the payer recognizes consultation codes and the consultation requirements are met. A diagnosis alone does not determine the level.

Use only when the payer recognizes consultation codes and the consultation requirements are met. A diagnosis alone does not determine the level.

Use only when the payer recognizes consultation codes and the consultation requirements are met. A diagnosis alone does not determine the level.

Use with an eligible time-selected hospital base service, following the CMS reporting threshold and counted-time window.