Discharge Services

Discharge day management services (99238-99239) seem unlikely to cause confusion in the physician community; however, continued requests for documentation involving these CPT codes prove the opposite.

Here’s an example of how a billing error might be made for discharge day management services. A patient with diabetes mellitus, hypertension, and chronic kidney disease is stable for discharge. The patient is being transferred to a skilled nursing facility (SNF). Dr. Aardsma prepares the patient for hospital discharge, and Dr. Broxton admits the patient to the SNF later that day. Dr. Aardsma and Dr. Broxton are members of the same group practice, with the same specialty designation. Can both physicians report their services?

FAQ

Question: A patient is admitted to the hospital but his condition warrants transfer to another facility, and he is discharged on the same day. How should the physician report his services?

Answer: Do not report 99238-99239 when the patient is admitted and discharged on the same calendar date. When this occurs, the physician selects from 99221-99223 (initial inpatient care) or 99234-99236 (admission and discharge on the same day). Choose 99234-99238 when the patient stay is >8 hours on the same calendar day and the insurer accepts these codes. Documentation must reflect two components of service: the corresponding elements of both the admission and discharge, and the duration of time the patient spent in the hospital. Alternately, if the patient stay is <8 hours, or the insurer does not recognize 99234-99236 (admission and discharge on the same day), report only initial inpatient care (99221-99223) as appropriate.7

Key Elements

Consider the basic billing principles of discharge services: what, who, and when.

Hospital discharge day management codes are used to report the physician’s total duration of time spent preparing the patient for discharge. These codes include, as appropriate:

  • Final examination of the patient;
  • Discussion of the hospital stay, even if the time spent by the physician on that date is not continuous;
  • Instructions for continuing care to all relevant caregivers; and
  • Preparation of discharge records, prescriptions, and referral forms.1

Hospitalists should report one discharge code per hospitalization, but only when the service occurs after the initial date of admission: 99238, hospital discharge day management, 30 minutes or less; or 99239, hospital discharge day management, more than 30 minutes.1,2 Select one of the two codes, depending upon the cumulative discharge service time provided on the patient’s hospital unit/floor during a single calendar day. Do not count time for services performed outside of the patient’s unit or floor (i.e., calls to the receiving physician/facility made from the physician’s private office) or services performed after the patient physically leaves the hospital.

Leave a Reply

Your email address will not be published. Required fields are marked *