General Surgery Coding Alert

Only one physician can report the discharge service You should always include hospital discharge services as part of the global surgical package for major procedures. But even in cases when you think the surgeon should be able to bill a separate discharge service (99238-99239), you should be on the lookout for these five problem areas.

Learn more: This is the second in a two-part series on hospital discharge coding. For more information on 99238-99239, see "Add $25 to Your Hospital Discharge Claims," General Surgery Coding Alert, September 2005. Keep an Eye for Observation Opportunities Sometimes a patient may not be eligible for a discharge code, says Jennie Horner, CPC, a coder with Southern Ohio Medical Center in Portsmouth, Ohio. This can happen if the patient never left the emergency department (ED) and thus was never admitted as an inpatient.

Solution: In this case, you should use the observation codes (99217-99220) instead of a hospital discharge.

Example: A patient arrives in the ED with several deep facial lacerations after falling from a bicycle and striking his head on the pavement. The surgeon tends to the patient's wounds and places the patient in observation for several hours to monitor his behavior. In this case, you would report the wound repair (for example, 12053, Layer closure of wounds of face, ears, eyelids, nose, lips, and/or mucous membranes; 5.1 cm to 7.5 cm), along with an appropriate-level observation code (such as 99219, Initial observation care, per day, for the evaluation and management of a patient ...). You should include the ED service as a part of the observation care.

One more to watch for: If the patient has a same-day admission and discharge, you would not report separate admission and discharge codes. Instead, you should select observation or inpatient care services (99234-99236). These services include same-day admission and discharge. Try for Face-to-Face Discharge Many experts believe that the physician must see the patient face-to-face on the discharge date to bill 99238 (Hospital discharge day management; 30 minutes or less) or 99239 (... more than 30 minutes), says Joan Gilhooly, CHCC, CPC, with Medical Business Resources in Evanston, Ill. So, if the surgeon last saw the patient the night before, she must bill subsequent care (99231-99233).

On the other hand, the CPT code descriptor appears to give some latitude to include only some of the discharge planning elements in 99238. And, you can bill 99238 for the work associated with a patient's death in the hospital, which doesn't necessarily involve a face-to-face visit.
 
Example: Sometimes the surgeon will see a patient in the evening and say [...]