Pediatric Coding Alert

Time-saver: You can ignore hospital dates when selecting 99435 If your newborn-inpatient encounter sheets are a picture of 99431s, 99433s and 99238s, your pediatrician could be stuck in a coding rut. To help her capture overlooked services, just highlight these points.
Tip 1. Track Discharge Time -- $31 Is at Stake Are your pediatricians leaving off minutes on their discharge day management notes? "Some payers require time documentation when billing for discharges (99238, Hospital discharge day management; 30 minutes or less; and 99239, ... more than 30 minutes)," says Barbara Avery, revenue cycle specialist at Woodbury Clinic in Minneapolis. Why bother? Code 99239 pays $31.45 more than 99238 using the 2007 Medicare Physician Fee Schedule. The cut-off for using 99239 is 31 minutes, says Richard Lander, MD, FAAP, pediatrician with Essex-Morris Pediatric Group in Livingston, N.J.
Tip 2: Include These Noncontiguous Services in 9923x Getting those extra dollars is fairly easy -- documentation-wise. All the pediatrician has to dictate is "spent over 30 minutes" on discharge day services, says Donelle Holle, RN, a pediatric nurse with more than 28 years of coding and billing experience for pediatric services. But before your pediatricians can capture 99239, they need the lowdown on what discharge day management entails. Give them these three pointers: 1. When counting time to select 99238 or 99239, use floor time, not just face-to-face time with the patient and/or family. 2. Codes 99238-99239 represent everything the pediatrician did that day to get the patient discharged, including: inpatient chart review discussions with the nurse regarding the patient final patient examination hospital stay discussion instructions for continuing care to all relevant caregivers discharge records preparation prescriptions and referral forms patient-related telephone calls on the unit. 3. The pediatrician does not have to perform all the services at the same time. When he sees the patient on rounds at 10 a.m., he could spend 15 minutes on the final exam and discussing the patient's hospital stay, Holle says. The pediatrician could then spend 15 minutes in the afternoon preparing the discharge records, giving instructions and writing prescriptions. Example: A pediatrician sends home a newborn who had transitory tachypnea of the newborn (TTN 770.6). The physician reviews the infant's hospital course in detail and discusses the stay with the parents. He addresses their concerns and informs them about signs of possible respiratory problems. Total discharge day management could easily take more than 30 minutes, making 99239 appropriate.
Tip 3: Use Combo Code for Early Go Home You won't, however, always use a discharge day code for a newborn that the pediatrician sends home. When a physician admits and discharges a normal newborn on the same day, do not report each service separately. Instead [...]