Cardiology Coding Alert

Reader Question:

AMA Status

Question: We receive a call from the floor nurse saying that our patient is checking out against medical advice (AMA) and our doctor has to return to the hospital and dictate a discharge summary that includes patient AMA. How do I bill this?

Florida Subscriber

Answer: This service should be coded using observation/ inpatient codes 99234-99236, says Terry Fletcher, BS, CPC, CCS-P, a coding and reimbursement specialist in Dana Point, Calif. These codes were created in 1998 to reimburse physicians for admits and discharges that occur on the same calendar date. (HCFA now is proposing to change the calendar date requirement to any 24-hour period.) A formal dictated note for the admit and discharge needs to be part of the medical record, particularly because of the patients AMA status.