Hospital Discharge Day Services

February 12th, 2009 - Codapedia Editor
Categories:   Coding   Evaluation & Management (E/M)  

Use codes 99238 or 99239 for services provided to a patient being discharged from inpatient status in the hospital.  These codes include all of the work performed on the calendar day to discharge a patient, including the exam, discussion with the patient and caregivers, and discharge paperwork.  They do not have specific history, exam or medical decision making requirements.

The first code, 99238, is for a discharge that takes 30 minutes or less.   Include in that time all discharge day activities, not just face-to-face time.  The second code, 99239, is for discharge day management that takes 30 or more minutes.  Document time in the discharge summary.  If you dictate the discharge summary, and note the time in the written progress note only, ask yourself this question:  if a payer asks for the discharge summary, will your Health Information Department print the discharge summary or go and find the paper record and copy what you wrote?  In most cases, they will re-print the discharge summary.  Document time there!

Only one physician may be paid for discharge day management.  Physicians of other specialties who see the patient that day should report/bill for a subsequent hospital visit.

A physician may bill for discharge from the hospital and admission to a nursing facility on the same calendar date, if the physician saw the patient in both locations and performed and documented the services required for both.  For the discharge, it is the discharge summary (along with the other work.)  For the admission to the nursing home, it is an admission service at the nursing home.  See the Codapedia article on nursing home services.

Sometimes, a physician sees the patient the day prior to discharge, and does most of the work of the discharge.  Perhaps that visit occurs on a Friday.  The next day, the physician or the physician's partner, provides a less extensive service.  Can the physician bill for the discharge on Friday and a subsequent hospital visit on Saturday? No.  All hospitals require that the patient is seen both days, so bill a subsequent hospital visit on Friday, and the discharge on Saturday.


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