Sometimes, when auditing an initial hospital service, either the history or the exam does not meet the level required for the lowest level of initial hospital service.  99221 requires all three of:  a detailed history, a detailed exam and straightforward or low medical decision making.  The MDM is typically higher, if you are admitting a patient to the hospital. If either the history or exam are not at that level, what to bill?

Bill the unlisted medicine code 99499.