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aleigh

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Hi there,
We bill for the NICU unit and pediatric physicians in a hospital. The NICU docs have indicated they discharged a baby out of the NICU into the care of the pediatric doc. They billed a 99238 on the day this did this discharge (transfer of care). Now the pediatric doc is trying to bill a discharge on the next day, when he discharged the newborn from the hospital.
Does transfer of care qualify as a discharge? I am confused on what to do in this situation..
Thank you for any light you can shine on the situation...
 
WOW
I think you have to look at the Inpatient Neonatal Critical Care Codes; 99468-99476 first and foremost. It would seem to me that your providers should be using these codes if they care for neonates in hospital. In regards to transfer for care, the provider who is taking over care of the patient should use subsequent care codes and then final d/c care codes if that provider is discharging patient from hospital. Just because your providers are discharging the patient from intensive care, they are not discharging the patient from the hospital, which is what the discharge codes are for - discharge from hospital.
very tricky coding; i think i am correct, but perhaps other can weigh in as well.

Carl
 
That was my thinking ...they should not be charging the discharge for a transfer. Thank you for your insight!
 
Below are the CPT instructions for transfers in the same facility from critical and intensive care to sick or well newborn care in case you need to share with the physicians.

When the critically ill neonate or pediatric patient improves and is transferred to a lower level of care to another individual in another group within the same facility, the transferring individual does not report a per day critical care service. Subsequent hospital care (99231-99233) or time-based critical care services (99291-99292) is reported, as appropriate based upon the condition of the neonate or child. The receiving individual reports subsequent intensive care (99478-99480) or subsequent hospital care (99231-99233) services, as appropriate based upon the condition of the neonate or child.

When the neonate or infant improves after the initial day and no longer requires intensive care services and is transferred to a lower level of care, the transferring individual does not report a per day intensive care service. Subsequent hospital care (99231-99233) or subsequent normal newborn care (99460, 99462) is reported as appropriate based upon the condition of the neonate or infant. If the transfer to a lower level of care occurs on the same day as initial intensive care services were provided by the transferring individual, 99477 may be reported.
 
Thank you that is very helpful!
One question...if the transferring doctor bills the subsequent care code what does the receiving doctor billed. Can they not both be paid for the same day? Seems conflicting for two docs to bill two care codes on the same day.
 
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It is not unusual for two physicians of different specialties or subspecialties to provide concurrent care (e.g., both billing for subsequent hospital visits on the same date). As long as medical necessity of each service is supported, both are reported. With a transfer of care situation, both physicians would likely have a significant service as one determines the patient is ready for and arranges the transfer and the other receives the patient and formulates a new plan of care.
 
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