Inpatient physician billing, done by specialists
The professional claim for the admitted patient. Hospital care, critical care, and discharge coded to the level the documentation actually supports, with the shared-visit and concurrent-care rules applied correctly.
The revenue is in the documentation, not the visit.
Since 2023 the visit level is set by medical decision making or total time, not history and exam. Code by habit and you either leave money behind or invite a recoupment.
- 01
Level chosen by MDM or total time
The 2023 E/M revisions moved hospital visit levels onto medical decision making or total time. We code to what the note supports, and tell you when the note does not support it.
- 02
Shared and split visits
When a physician and an advanced practice provider both see the patient, the substantive-portion rule decides who bills. We apply it correctly instead of defaulting to the physician.
- 03
Concurrent-care denials
Two physicians, same patient, same day: payers deny one unless each role is documented and distinct. We keep the documentation clean and appeal the denials that still land.
- 04
Under-leveling recovery
Downcoded initial and subsequent care is revenue silently left behind, every rounding day. We audit the E/M mix against documentation and recover what was under-billed.
We code to the documentation, not to habit.
The hospital E/M families every admitted-patient claim runs on, billed at the level the note supports and defended when a payer asks.
| CPT code | Time band | Description |
|---|---|---|
| 99221–99223 | Initial care | Initial hospital inpatient or observation care |
| 99231–99233 | Subsequent care | Subsequent hospital care, per day |
| 99238–99239 | Discharge | Hospital discharge day management |
| 99291–99292 | Critical care | Critical care, time-based |
| 99252–99255 | Consultation | Inpatient consultations, payer-dependent (not payable by Medicare) |
We know how each payer reads a hospital claim.
Leveling scrutiny, consult-code policy, and concurrent-care rules differ by payer. We track the differences so claims are built the way each one expects.
- MedicareMPFS · MAC leveling policy
- MedicaidState plans & managed care
- CommercialAetna · Cigna · UnitedHealthcare
- Blue CrossPlan-by-plan E/M policy
See what your inpatient claims are leaving behind.
A no-obligation review of your E/M mix, denials, and documentation, with a recovery estimate on what was under-leveled.