Thursday, June 14, 2012

Know How to Report Discharge Services

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

Answer: You must not report 99238-99239 when the patient is admitted and discharged on the same date of calendar. When this takes place, the physician picks from CPT 99221-CPT 99223(initial inpatient care) or 99234-99236(admission and discharge on the same day). Choose 99234-99238 when the patient stay is less than 8 hours on the same calendar day and the insurer agrees with these codes. Documentation should mirror two components of service: the corresponding elements of both the admission as well as the discharge, and the period of time the patient spent in the hospital. Interchangeably, in case the patient stay is less than 8 hours, or the insurer does not recognize 99234-99236(admission and discharge on the same day), report only initial inpatient care CPT 99221- CPT 99223 as appropriate.

Key Elements

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

Hospital discharge day management codes are essentially used to report the physician's total extent of time spent preparing the patient for discharge. These codes involve, as appropriate:
  • Final examination of the patient;
  • Discussion of the hospital stay, even though the time spent by the physician on that date is not continuous;
  • Guidelines for continuing care to all pertinent caregivers; and
  • Preparation of discharge records, prescriptions, as well as referral forms.

Hospitalists must report one discharge code per hospitalization, however only when the service takes place after the admission's initial date: 99238, hospital discharge day management, 30 minutes or less; or 99239, hospital discharge day management, more than 30 minutes. Choose one of the two medical coding and billing codes, hinging on the cumulative discharge service time given on the patient's hospital unit/floor during a single calendar day. You must not count time for services carried out 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 carried out after the patient physically leaves the hospital.

Transfers of Care

The admitting physician or group is accountable for carrying out discharge services unless a formal transfer of care takes place, for instance the patient's transfer from the ICU to the standard medical floor as the patient's condition becomes better. Without this transfer of care, co-managing physicians must simply report subsequent hospital-care codes , CPT 99231- CPT 99233, for the final patient encounter. A sample of this is surgical co-management: In case a surgeon is acknowledged as the attending of record, they are in charge for postoperative management of the patient, including discharge services.

Providers in a dissimilar group or specialty report CPT 99231- CPT 99233 for their medically necessary care.