Forum - Questions & Answers

Sep 17th, 2009 - cbishop 3 

Discharge summary dictated day prior to discharge

The Medicare Claims Processing Manual section 30.6.9.2 states "The E/M discharge day management visit shall be reported for the date of the actual visit by the physician or qualified NPP, even if the patient is discharged from the facility on a different calendar day". If my doctor dictates the discharge summary on the day prior to the patient going home, should the discharge visit 99238-99239 be billed on the day the discharge summary was dictated?

Sep 17th, 2009 -

Yes

If the physician did the work on the day prior, you bill that day. That assumes the patient was not seen on the discharge day. If the summary was dictated the previous day but the patient was seen and sent home on the next day, bill that day as discharge. The work includes reconciling meds, writing prescriptions, counseling patient, etc.



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