Subsequent hospital care, per day, typically 35 minutes
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Insufficient documentation for moderate complexity follow-up
Very Common99232 is most common subsequent hospital code (moderate complexity). Requires moderate MDM each day: responding to treatment changes, new problems emerging, or complex stable condition management. Denials when daily note doesn't show moderate decision-making - routine stable patient should be 99231. Must document what changed, what data reviewed, what decisions made each day.
Common Causes
- • Patient clinically stable without new problems - should be 99231
- • No documentation of data reviewed daily (labs, imaging)
- • Treatment plan unchanged for multiple consecutive days
Resolution Strategy
Provider documents moderate daily MDM: new test results interpretation, treatment adjustments, consultant recommendations implementation. If patient truly stable, accept 99231 for stable days, 99232 for days with changes.
💬 Plain Language Explanation
What this means
This is a hospital visit - a visit from your doctor while you were in the hospital. Your doctor checked on you and made moderate medical decisions about your care.
Why you might see this
This is a common code for hospital visits. You might see this for daily visits from your doctor while you were hospitalized that required moderate medical decision-making.
Common context
Used for hospital visits that require moderate medical decision-making.
What to ask your provider
"'What made this hospital visit moderately complex? What medical decisions were made?'"
Relative Value Units (RVUs)
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Clinical Information
When to Use
Subsequent hospital care with moderate complexity medical decision making
Common Scenarios
Documentation Requirements
- Detailed interval history
- Detailed examination
- Moderate complexity medical decision making
- Modification of treatment plan with rationale
Coding Guidelines
Common Modifiers
Bundling Rules
- Cannot be billed with other E/M codes same date by same physician
- Includes multiple visits on same date if performed
- Cannot be billed on admission or discharge date
Exclusions
- 99221-99223 (initial hospital care codes)
- 99238-99239 (discharge day management)
- 99231, 99233 (different complexity levels)
Coding Notes
Clinical scenarios
- Detailed interval history
- Detailed examination
- Moderate complexity medical decision making
- Detailed interval history
- Detailed examination
- Moderate complexity medical decision making
- Detailed interval history
- Detailed examination
- Moderate complexity medical decision making
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Frequently Asked Questions
CPT 99232 is the billing code for "Subsequent hospital care, per day, typically 35 minutes". Subsequent hospital care with moderate complexity medical decision making
Medicare pays approximately $76.34 for CPT 99232 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 99232 has a total RVU of 2.82, broken down as: Work RVU 1.76, Practice Expense RVU 0.93, and Malpractice RVU 0.13. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 99232 is "Insufficient documentation for moderate complexity follow-up". 99232 is most common subsequent hospital code (moderate complexity). Requires moderate MDM each day: responding to treatment changes, new problems emerging, or complex stable condition management. Denials when daily note doesn't show moderate decision-making - routine stable patient should be 99231. Must document what changed, what data reviewed, what decisions made each day. Common causes include: Patient clinically stable without new problems - should be 99231; No documentation of data reviewed daily (labs, imaging). Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 99232 include: Detailed interval history; Detailed examination; Moderate complexity medical decision making; Modification of treatment plan with rationale. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 99232: Cannot be billed with other E/M codes same date by same physician. Includes multiple visits on same date if performed Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 99232 include: AI (Principal physician of record), 25 (Significant, separately identifiable E/M on same day as procedure). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 99232 is Typically 35 minutes of total time on date of encounter. Time-based codes require documentation of the actual time spent providing the service.