Neurology & Pain Management Coding Alert

Air-tight documentation will guarantee your 99238-99239 claims When the neurologist reports hospital discharge services, don't take the chance of forfeiting the $75 to $100 that Medicare allots for these codes. Follow these three tips to improve your documentation and your chances at fair reimbursement. 1. Don't Forego Face-to-Face Meetings The Question: What should you do if the neurologist gives a discharge order for a patient, then talks to the nurses and dictates the summary but does not conduct a patient exam before the patient leaves the hospital?

The Facts: CPT does not directly state that face-to-face encounters are necessary during discharge (leaving it to physicians to determine whether such encounters are appropriate), but the guidelines imply that physicians should meet with patients during the discharge process.

Face-to-face contact with patients is inherent in all CPT E/M codes, including discharge summaries. Therefore, most coding consultants suggest that you be sure the neurologist documents that he was physically in the room with the patient.

Indeed, the whole issue of face-to-face encounters with physicians during discharges is controversial, says Catherine Brink, CMM, CPC, president of Healthcare Resource Management of Spring Lake, N.J.

Protect Yourself: Consult your carrier if you're not sure about face-to-face exam requirements, Brink says. Some payers publish specific guidelines that address this topic. HGSAdministrators, a Pennsylvania Part B carrier, printed the following in its E/M Documentation Guideline FAQs:

"When a patient is discharged prior to the daily visit by the physician, a discharge day management service can be billed to Medicare if the medical record includes documentation of a service rendered, e.g., instructions for continuing care to all relevant caregivers and preparation of discharge records, prescriptions and referral forms."

The insurer states, however, that it "would expect to see that this is rare, and that the majority of the patients that are discharged are seen face-to-face by the physician for a final examination." In other words, you should always make the effort to document a face-to-face encounter with the patient and physician, or to provide a clear explanation of why such a meeting was not necessary.

Neurologists should report discharge codes (99238, Hospital discharge day management; 30 minutes or less; or 99239, ... more than 30 minutes) in the following scenarios:
  
Trauma not requiring surgery. When admitting trauma patients who do not require surgery, you should report a separate discharge service at the time of the patient's release.

Nonsurgical conditions. If the neurologist admits a patient for treatment of nonsurgical conditions, you may report discharge services in most cases.

You should report 99238 and 99239 for "all services provided to a patient on the date of discharge, if other than the initial date of inpatient status," according to CPT.
These codes are time-based, and you should report 99239 only [...]