Wiki Inpatient transfer of care - The doctor has been


Highlands ranch, CO
Best answers
The doctor has been this patient's PCP for a long time. The patient is in the hospital for months and the doctor has decided to transfer his care to the hospitalists. He dictated a discharge summary and spends over 30 minutes coordinating his transfer to the hospitalists and giving a summary of the inpatient course of his care.

What E/M code do I use? I was thinking 99239, but the patient is still in the hospital at this time.
Subsequent visit w/ prolonged service

You cannot use discharge day management codes, because the patient has not been discharged.

You would code the documented level of subsequent hospital visit, and IF THE TIME WAS RECORDED AND SPENT AT THE BEDSIDE - you could also use prolonged service codes.

However, if the time spent documenting all his notes was done NOT at the bedside, then he's just out of luck, billing wise. Good patient care, though.

Hope that helps.

F Tessa Bartels, CPC, CEMC
Inpatient discharge

You cannot charge a discharge, however you can charge a subsequent and the prolonged if you meet the guidelines by CPT. Inpatient prolonged includes total time on the floor and face-to-face.

Per CPT Assist 2009
Revisions were also made to clarify the appropriate use of codes 99356-99357. These codes are reported in the inpatient setting and are used to report the total duration of unit time spent by a physician on a given date, providing prolonged services to a patient, even if the time spent by the physician on that date is not continuous. Again, the total amount of prolonged service time beyond the typical time of the primary E/M service would be used to select the appropriate prolonged service code.

The guidelines further state that either code 99354 or 99356 should be used only once per date of service. Prolonged service of less than 30 minutes total duration on a given date, is not separately reported because the work involved is included in the total work for the E/M codes.