Gastroenterology Coding Alert

Question: Should we bill for both a subsequent hospital-care visit and a hospital discharge on the same day? Our gastroenterologist examined the patient early in the day and then several hours later discharged the patient. Texas Subscriber Answer: No, the general rule is that you can bill for only one E/M service a day, and you should bill only for the hospital discharge (HD) service. The HD codes (99238-99239) should be used by physicians to report ALL services provided to a patient on the date of discharge, if it occurs on a date other than the initial day of inpatient status, according to CPT 2002. The HD codes are based on time instead of the usual key components of history, examination and medical decision-making. They cover the final examination of the patient, discussion of the hospital stay, instructions for continuing care to the patient or all relevant caregivers and the preparation of the discharge papers. Code 99238 should be used to report discharge services that are 30 minutes or less in duration, while 99239 should be used to report services that take longer than 30 minutes. The codes are used to report the total time spent on these activities, even if the time spent by the physician on that day is not continuous. Therefore, you should include the time spent earlier in the day examining the patient when figuring out which discharge code to use. Most HDs, however, usually take less than 30 minutes.