Otolaryngology Coding Alert

Question: During morning hospital rounds, an otolaryngologist discusses treatment plans with a patient and his spouse. The same afternoon, the physician discharges the patient. Due to the patient's special needs, the physician spends 45 minutes coordinating his care. How can the provider receive payment for the amount of time he spends with family on the discharge day?


New Hampshire Subscriber


Answer: Assuming the otolaryngologist documented the total time in the chart, you should use hospital discharge code 99239 (Hospital discharge day management; more than 30 minutes).

CPT contains two discharge codes. For discharge services that take 30 minutes or less of floor time, you should report 99238 (... 30 minutes or less). But when the otolaryngologist spends and documents more than 30 minutes of floor time on discharge services, you should instead assign 99239. You should count floor time, not face-to-face time as you do with outpatient codes.

Watch out: You shouldn't separately bill the morning encounter. Payers won't reimburse two same-day E/M services. Furthermore, CPT states, "The hospital discharge day management codes are to be used to report the total duration of time spent by a physician for final hospital discharge of a patient."

Better way: You should instead combine the total time the otolaryngologist spends coordinating the patient's care on the discharge day. Tally the documented minutes to determine whether to report 99238 or 99239.

Remember that 99238 and 99239 describe discharge day management, not just discharge services. The time does not have to be continuous.

In addition, when counting discharge day service time, include these services:
  the patient's final examination
  the hospital stay discussion
  continuing-care instructions to all relevant caregivers
  discharge records, prescriptions and referral forms preparation. Tip: Encourage your otolaryngologist to record start and stop times to show an auditor that he's conscious of time management. Documenting total minutes is less definite.

Tell your physician that taking the extra time to carefully document discharge day management services may pay off.
 
Code 99239 reimburses at a national rate of $96.64 - over $25 more than 99238 pays on average. The 2005 National Physician Fee Schedule assigns 1.87 relative value units ($70.87 geographically unadjusted rate) to 99238 and 2.55 RVUs ($96.64 national rate) to 99239.