When a patient requires an overnight stay in a hospital, the medical services provided are categorized into distinct phases. These services, known formally as Evaluation and Management (E/M) services, ensure continuous attention from the attending physician. The daily monitoring between the initial assessment and final departure is captured under a formal designation. This ongoing management of an admitted patient is known as subsequent hospital care, clarifying how medical professionals structure their daily oversight.
Defining Subsequent Hospital Care
Subsequent hospital care is the comprehensive, daily medical attention given to a patient who has been admitted to the hospital and remains an inpatient or in observation status. This designation applies to the visits and management services provided by the attending physician on every calendar day following the initial admission visit. It represents the consistent effort to manage the patient’s condition, track their progress, and adjust the treatment plan.
The concept is formalized through medical coding systems that assign specific codes, such as CPT codes 99231 through 99233, to these daily services. A physician or qualified healthcare professional may only bill for one subsequent care service per patient per calendar day, reflecting all evaluation and management work performed that day. The level of complexity in the patient’s condition determines which of the three specific codes is assigned for the visit.
The purpose of subsequent care is to ensure continuous oversight of the patient’s status while they are receiving hospital-based treatments. It is a per diem service, meaning it is defined and billed as a single unit of care for that day, regardless of the number of times the physician checks on the patient. This period begins after the initial admission work is complete and continues until the patient is formally discharged from the facility.
The Daily Focus of Subsequent Care
The daily focus of subsequent hospital care centers on the physician’s evaluation of the patient’s response to treatment since the last visit. This involves a meticulous review of the medical record, including laboratory results, imaging studies, and nurses’ notes to track any changes in the patient’s clinical picture. The physician performs a focused physical examination and gathers an interval history, concentrating only on the events and symptoms that have occurred since the prior day’s evaluation.
A significant part of this daily work is adjusting the treatment plan based on the collected data and the patient’s current status. This can involve modifying medication dosages, discontinuing a drug causing a side effect, or changing fluid management protocols. For instance, a physician might decrease the rate of an intravenous antibiotic if infection markers are improving or order a new diagnostic test if the patient’s fever persists.
The complexity of the medical decision-making required for that day dictates the intensity of the subsequent care service. If the patient is stable and improving, the visit requires a lower level of complexity (CPT 99231). Conversely, if the patient is responding poorly to therapy, has developed a complication, or requires significant changes to multiple treatments, the visit requires a high level of medical decision-making (CPT 99233).
Coordination of care is another primary activity during these daily visits, especially for patients with complex illnesses. The attending physician frequently communicates with consulting specialists, such as cardiologists or nephrologists, to integrate their recommendations into the overall treatment plan. Communication with the patient and their family regarding the day’s progress and anticipated next steps is also a fundamental component of the subsequent care service.
Distinguishing Subsequent Care from Admission and Discharge
Subsequent hospital care is defined by its position as the middle, continuous phase of a patient’s hospital stay, distinct from the services that bookend it. The process begins after Initial Hospital Care, the comprehensive evaluation and management service provided on the day the patient is admitted. The initial visit is generally more complex, requiring a detailed history and examination to establish the diagnosis and initial treatment plan.
In contrast, subsequent care visits are less resource-intensive because the physician focuses only on changes since the day before, rather than performing a complete workup. CPT guidelines reflect this difference by requiring documentation of all three key components (history, exam, and medical decision-making) for the initial visit, but only two for a subsequent visit. This reduced documentation requirement acknowledges the more focused nature of the daily progress note.
The subsequent care phase ends when the physician begins the formal Hospital Discharge Services, which are coded separately as CPT 99238 or 99239. These discharge services cover the final activities of the hospital stay, including preparing discharge summaries, writing prescriptions, and providing detailed instructions for follow-up care and recovery at home. Subsequent hospital care serves as the continuous management that drives the patient from the initial acute crisis of admission to the final preparation for discharge.