Primary Care Coding Alert

Question: My family physician (FP) attends to a badly burned boy in the hospital and discharges him to a burn hospital on the same day. She does not admit the patient to the hospital but sees him on rounds during the morning and later discharges him. How should I bill the days E/M services?


Washington Subscriber

Answer: In general, physicians should use the hospital discharge day management codes, 99238 (Hospital discharge day management; 30 minutes or less) and 99239 ( more than 30 minutes), to report all services provided to a patient on the date of discharge, if other than the initial date of inpatient status, according to CPT. Thus, in this case, you should bill the days E/M services using the appropriate hospital discharge management code. Select the code based on the total duration of time the FP spends on final hospital discharge of a patient. Use 99238 for hospital discharge day management of 30 minutes or less. For discharge services involving more than 30 minutes, report 99239.

If the FP also performs the hospital admission on the same date, however, you should instead assign 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date ) for the same-day admission and discharge. For instance, if the FP in your example admits the patient to the hospital before discharging him, you should report one code for the same-day admission and discharge (99234-99236).


If the physician provides critical care services to the patient, you should separately report them. Critical care and other E/M services may be provided to the same patient on the same date by the same physician, CPT states. Do not, however, count the time spent in critical care toward the time spent in discharge day management and vice versa; the time spent in each is intended to be mutually exclusive.

Depending on the boys age and the services rendered, the pediatric critical care codes (99293, Initial pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child; and 99294, Subsequent pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child) or the adult critical care codes (99291, Critical care, evaluation and management of the critically ill or injured patient; first 30-74 minutes; and +99292 each additional 30 minutes [list separately in addition to code for primary service]) may apply.