In-Hospital Emergency FAQs

An in-hospital emergency occurs when a hospital in-patient (or other non-ED patient) is determined to have an emergent condition by the nurse or other healthcare provider monitoring the patient's condition, and no other physician is available to provide emergency care for the patient.

See ACEP's policy statement on Emergency Physician Response to In-Hospital Emergencies Outside the Emergency Department for more information.

There are no specific CPT codes that describe an ED physician responding to an in-hospital emergency. The appropriate CPT code would be those that align with the patient's condition and the interventions performed by the ED physician.

Services that meet the threshold for critical care would be reported using CPT codes 99291 and 99292. These time-based codes are applicable when the patient is experiencing a critical illness or injury that poses a significant risk of imminent or life-threatening deterioration in their condition. Critical care billing mandates documentation of the total time spent by the physician/QHP in providing critical care services. See the Critical Care FAQ for more information.

Should the provided services not satisfy the criteria for critical care, the emergency physician may report a Hospital Inpatient/Observation Care E/M code. The assignment of these codes is determined by the complexity of the medical decision making during the encounter. Initial Hospital Inpatient or Observation Care E/M codes (99221-99223) are employed when the patient has not previously received professional services from the attending ED physician/QHP or another physician/QHP of the same specialty from the same practice group during the hospital stay.

If the patient was admitted to the hospital from the emergency department, the responding ED physician should report the in-hospital emergency encounter using the appropriate Subsequent Hospital Inpatient/Observation Care E/M codes (99231-99233). Additionally, if both emergency department and inpatient services are provided on the same day, modifier 25 may be appended to the second E/M service code to denote a significant and separately identifiable service performed by the same physician/QHP.

When the ED physician performs billable procedures (e.g., intubation, central line insertion, control of epistaxis, cardiopulmonary resuscitation), the relevant CPT codes should be reported.

Coders and billers should ensure the appropriate place of service code is reported on the claims for these services. The place of service code indicates the setting where a patient receives medical services. The code for Inpatient Hospital is 21 (versus 23 for emergency room), and it should be reported for patients who are registered inpatients, regardless of where the face-to-face encounter occurs. If the patient is not an inpatient or an emergency patient, the place of service is 22 for On Campus – Outpatient Hospital.