Orthopedic Coding Alert

Don't let poor documentation sink your 99238-99239 claims Orthopedists report hospital discharge codes more often than they report the closed tibia and femur fracture care codes (27750, 27500) combined - so you can't afford to glaze over the requirements for these codes. Increase your chances of collecting the $75 to $100 that Medicare allocates for discharge services with these key documentation details.
 
Take note: If an orthopedic surgeon performs surgery and discharges the patient during the global period, he cannot report hospital discharge codes (99238, Hospital discharge day management; 30 minutes or less; or 99239, ... more than 30 minutes). But if the patient is admitted to the hospital and the orthopedist does not perform surgery, you can normally report a discharge.
  
Physicians should report discharge codes in the following scenarios:
 
Trauma not requiring surgery. Orthopedists may also report discharge services when they admit trauma patients who do not require surgical treatment.
 
Nonsurgical conditions. If an orthopedist admits a patient for treatment of nonsurgical conditions like arthritis, discharge services may be appropriate. CPT specifies that 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." These codes are time-based, so you should report 99239 only if the orthopedist spends more than 30 minutes performing discharge services.
 
Coding experts recommend these three strategies for improving payment for discharge services. 1. Don't Forego Face-to-Face Meetings Snag: What should you do if the orthopedist 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?
 
Reality: 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, so most coding consultants believe that orthopedists should document that they were 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.
 
Smart move: 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 [...]