General Surgery Coding Alert

Question: One of our surgeons saw a patient in the hospital and coded the visit as 99233 (Subsequent hospital care ...). He noted in his documentation the patients problems and that later in the day her condition stabilized. He returned to the hospital the same day to arrange her discharge. Can I bill the hospital discharge code 99238 in addition to 99233, or am I restricted to using just 99238 because the surgeon discharged the patient the same day? Wisconsin Subscriber Answer: You can bill only one hospital code: 99238 (Hospital discharge day management; 30 minutes or less). CMS addresses this in the Medicare Carriers Manual, section 15505.2, stating, "Pay only the hospital discharge management code on the day of discharge. Do not pay both a subsequent hospital visit in addition to hospital discharge day management service on the same day by the same physician."

Medicare considers all work performed by the physician on the discharge date "rolled" into the discharge. The time you spend with the patient on the date of discharge does not have to be continuous.