Primary Care Coding Alert

Question: My family physician sees a patient in the hospital, pronounces him dead, and dictates a discharge summary. Should I code for discharge services or subsequent hospital care?

Alabama Subscriber Answer: If your FP performs and documents a discharge, you may bill hospital discharge day management (99238, Hospital discharge day management; 30 minutes or less; 99239, ... more than 30 minutes). In the case of a patient death, CPT allows you to report 99238-99239 as long as your FP performs any of the hospital discharge services, such as counseling or discharge records preparation.

Many physicians, however, bill only a daily visit (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...) when patients die. They reason that the discharge service codes cover a lot more than dictating the summary. Codes 99238-99239 include, "as appropriate, final examination of the patient, discussion of the hospital stay ... instructions for continuing care to all caregivers, and preparation of discharge records, prescriptions and referral forms," CPT states.

When discharging dead patients, many FPs don't feel they performed the level of service that 99238-99239 indicate. Therefore, you may consider reporting subsequent hospital care, rather than a discharge service.