Time Requirements for Level 3 Subsequent Hospital Visit (CPT 99233)
CPT 99233 requires a minimum of 35 minutes of face-to-face time with the patient on the hospital floor or unit.
Time-Based Coding for Subsequent Hospital Care
The Current Procedural Terminology (CPT) coding system establishes specific time thresholds for subsequent hospital care visits, which are distinct from initial hospital care encounters 1:
- CPT 99231 (Level 1): Typically 15 minutes
- CPT 99232 (Level 2): Typically 25 minutes
- CPT 99233 (Level 3): Typically 35 minutes
Critical Coding Requirements
Face-to-face encounter definition: The time must represent actual bedside or floor/unit time spent with the patient, not cumulative time spent on the patient's care throughout the day 1, 2. This distinguishes it from non-face-to-face evaluation and management services, which use different coding structures 2.
Documentation essentials: The medical record must clearly document the total time spent and that more than 50% of the encounter was spent in counseling and/or coordination of care if using time as the determining factor for code selection 1, 3.
Common Pitfalls to Avoid
Undercoding is prevalent: Studies demonstrate that 72% of visits coded at lower levels could have been appropriately coded at higher levels, particularly in teaching settings where residents and faculty may not fully understand CPT coding rules 3. This represents significant lost revenue and undervalues the complexity of care provided.
Time aggregation error: Physicians cannot "roll up" multiple brief encounters throughout the day to meet the 35-minute threshold 1. Each subsequent hospital visit code represents a single, continuous face-to-face encounter.
Telemedicine limitations: For subsequent hospital care services delivered via telemedicine, Medicare permits only 1 telemedicine visit every 3 days, and the same time requirements apply 4.
Alternative Coding Pathways
When the 35-minute threshold is not met but the medical decision-making complexity is high, CPT 99233 can still be selected based on the level of medical decision-making rather than time 3. However, the documentation must clearly support the complexity of the patient's condition and the physician's cognitive work.