Wiki How to code Inpatient Discharge when pt is getting d/c to higher level of care???

[dominicchavez20]

Good Morning Fellow Coders,
I have a question for all you Facility (Inpatient) Coders out there.
When a patient gets xferred to a higher level of care upon being "discharged", how would you go about coding the patients Discharge encounter?
Are there specific rules/guidelines when a patient isn't discharged home, and instead gets discharged to a diff hospital for a higher level of care?

Thanks in advance!

Respectfully,

Dominic J. Chavez, CPC

 

[TThivierge]

Hello Dominicchavez

Here is some data may help you understand the IP scenario on discharge. When the treating physician has completed a discharge summary certain processes in written order format.. The discharge summary should be signed and attest include patient s care, state they were inpatient status , final assessment /dx codes, ancillary type of care and all problems include during inpt. stay. Believe the provider has 3 days to get this completed. If going home or to another facility need this discharge summary finished. Usually these other facility or med centers have own tax ID and NPI numbers.
In the Inpt. setting use 2 digit discharge codes set on UB92 inpat billing form. As example Disch. code 63 for inpat. rehab, Discharge code 01 for home, Disch 20 patient expired, Disch code 07 is left against med advice AMA, Disch code 65 pt to psych unit in written order format since maybe part of hospital.

The Discharge CPT code 99238 or 99239 should be used when pt is discharge out of that facility. If the patient is going to let s say inpt. rehab facility or nursing home still need a discharge summary completed with info stated below. The new treatment place will need this data for admission (dx codes demographic info on pt). If patient being transferred to another medical floor that should be documented too in a transfer note, but done with subsequent care inpt. pt. code of 99231- 99233. So let us say patient discharge from medicine floor (cured) then sent to psych floor all same week in same facility.

Also do not bill discharge summary CPT 99238-99239 codes if on same day as initial CPT inpt codes.

Keep in mind differ medical dx code are linked to MS DRG codes which is of course selected by the physician treating the patient as final dx codes& affects reimbursement and age, sex, and major procedures performed .

Observation inpt.CPT codes can be done on same day as inpt. admit then discharge .Observe pt then release with discharge summary too since leaving care to go home or to another floor if complications or another higher care facility.

Subsequent inpt. CPT code when inpt. range from CPT 99231-99233

If time in discharge over 100 minutes, add prolonged service codes CPT 99418 but should be noted in the med documentation for the day by provider.

Please review pages 16-18 in the year 2024 CPT manual for more data

I hope this info helps you
Lady T