Hospital discharge, nursing facility admit billable on same day by same provider in most instances

November 18th, 2013 - Scott Kraft
Categories:   Billing   Evaluation & Management (E/M)  
0 Votes - Sign in to vote or comment.

Medicare will typically pay for a hospital discharge service (billed with 99238-99239) and a nursing facility admission visit (99304-99306) when billed on the same date of service (DOS) by the same provider without the need for a modifier. As always, however, there are a couple of exceptions.

The discharge day management services are billed for the services provided to the patient at discharge. You use 99238 for a service of 30 minutes or less and 99239 for services of 31 minutes or more. The pay difference between the services is approximately $35, depending upon where you’re located.

Discharge services run the gamut from the exam provided to the patient that day, furnishing of discharge instructions, arrangement of follow-up care after the hospitalization, writing prescriptions, etc. The service technically does not need to always be billed on the actual date of discharge, but can be billed only once during the hospitalization.

When the same provider admits the patient to the skilled nursing facility or nursing facility, the physician may bill the appropriate admission code from the 99304-99306 range.

Of the admit codes,99304 requires a detailed or comprehensive history and exam and medical decision making of straightforward or low complexity; 99305 requires a comprehensive history and exam and medical decision making of moderate complexity; 99306 requires a comprehensive history and exam and medical decision making of high complexity.

The exception: A surgeon cannot bill for an admission to a nursing facility when the reason for the admission is directly related to the surgery that has a global period. In that case, the nursing facility admit and any subsequent nursing facility services are including in the global payment for the surgery, according to CMS.

The exception to the exception: When the surgeon refers the patient to a nursing facility for a reason that is not related to the surgery, the surgeon may bill the nursing facility admit along with modifier 24 for unrelated E/M services during a global period.

One last reminder: When the patient is admitted to and discharged from inpatient status on the same date of service, don’t bill 99238-99239. Instead, bill the appropriate code from the 99234-99236 series.

These policies are detailed in Medicare’s Internet Only Manual, Pub. 100-04, Chapter 12, Section


Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

Medicare Updates -- SNF, Neurostimulators, Ambulance Fee Schedule and more (2022-10-20)
October 27th, 2022 - CMS - MLNConnects
Skilled Nursing Facility Provider Preview Reports: Review by November 14 - Help Your Patients Make Informed Health Care Decisions - Ambulance Fee Schedule: CY 2023 Ambulance Inflation Factor & Productivity Adjustment - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes...
2023 Evaluation & Management Updates Free Webinar
October 24th, 2022 - Aimee Wilcox
Congratulations on a successful 2021 implementation of the Evaluation and Management (E/M) changes! That was a big change, but now an even bigger change is headed your way for inpatient and all other E/M categories. How great is it that almost all of the E/M categories will now be scored based on medical decision making (MDM) or total provider time? Standardized scoring and one set of E/M guidelines has the potential of bringing about a change or improvement of provider fatigue due to over regulation and documentation burden.
Are Leading Queries Prohibited by Law or Lore?
October 13th, 2022 - Erica E. Remer
AHIMA released its CDI Practice Brief Monday. At Yom Kippur services, I found myself thinking about the question Dr. Ronald Hirsch posed to me the day before. My rabbi was talking in her sermon about the difference between halacha and minhag. Halacha is law; it is the prescriptions...
2023 ICD-10-CM Guideline Changes
October 13th, 2022 - Chris Woolstenhulme
View the ICD-10-CM Guideline Changes for 2023 Chapter 19 (Injury, poisoning, and certain other consequences of external causes [S00-T88])The guidelines clarify that coders do not need to see a change in the patient’s condition to assign an underdosing code. According to the updated guidelines, “Documentation that the patient is taking less ...
Z Codes: Understanding Palliative Care and Related Z Codes
October 11th, 2022 - Gloryanne Bryant
Palliative care is often considered to be hospice and comfort care. Palliative care is sometimes used interchangeably with “comfort care” and then again sometimes with “hospice care.”  But these terms do have slightly different meanings and sometimes the meaning varies depending on who is stating it. The National...
2023 ICD-10-CM Code Changes
October 6th, 2022 - Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
In 2022 there were 159 new codes; the 2023 ICD-10-CM code update includes 1,176 new, 28 revised, and 287 deleted codes, a substantial change from last year. The 2023 ICD-10-CM codes are to be used for discharges from October 1, 2022 through September 30, 2023, and for patient encounters from ...
Yes, You Have What It Takes To Lead Your Practice And Your Profession
September 20th, 2022 - Kem Tolliver
If you’ve been in any healthcare role for more than two years, you’ve seen quite a bit of change. And guess what, it’s not over. We are living and working in uncertain times. This climate requires each of us to step outside of our comfort zones to lead exactly where we stand. It’s not required of one to have a “title” to lead. What is required, however, is a willingness to trust your instincts, look for answers and rely on your team.

Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association