Medicare ICU & Discharge Reimbursement

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Please help! Our office had a pt who was in ICU for 3 days and then passed away :(. So Medicare reimbursed us only for the ICU charges and not the Discharge. I've appealed it, but got denied. Does anyone know if the discharge is payable? If so, how?? Please let me know. Thank you!!
 
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Selden
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The discharge would be payable only if your physicians were the attending physician AND they also pronounced the patient. Otherwise, it should be billable with another appropriate inpatient code (either critical care, if that applies 99291-99292, or subsequent visit 99231-99233).
The relevant portion is in 30.6.9.2 section B & E

B. Hospital Discharge Day Management Service
Hospital Discharge Day Management Services, CPT code 99238 or 99239 is a face-to-face evaluation and management (E/M) service between the attending physician and the patient. The E/M discharge day management visit shall be reported for the date of the actual visit by the physician or qualified nonphysician practitioner even if the patient is discharged from the facility on a different calendar date. Only one hospital discharge day management service is payable per patient per hospital stay.

Only the attending physician of record reports the discharge day management service. Physicians or qualified nonphysician practitioners, other than the attending physician, who have been managing concurrent health care problems not primarily managed by the attending physician, and who are not acting on behalf of the attending physician, shall use Subsequent Hospital Care (CPT code range 99231 - 99233) for a final visit.

Medicare pays for the paperwork of patient discharge day management through the pre- and post- service work of an E/M service.


E. Hospital Discharge Management and Death Pronouncement
Only the physician who personally performs the pronouncement of death shall bill for the face-to-face Hospital Discharge Day Management Service, CPT code 99238 or 99239. The date of the pronouncement shall reflect the calendar date of service on the day it was performed even if the paperwork is delayed to a subsequent date.
 
Messages
8
Best answers
0
The discharge would be payable only if your physicians were the attending physician AND they also pronounced the patient. Otherwise, it should be billable with another appropriate inpatient code (either critical care, if that applies 99291-99292, or subsequent visit 99231-99233).
The relevant portion is in 30.6.9.2 section B & E

B. Hospital Discharge Day Management Service
Hospital Discharge Day Management Services, CPT code 99238 or 99239 is a face-to-face evaluation and management (E/M) service between the attending physician and the patient. The E/M discharge day management visit shall be reported for the date of the actual visit by the physician or qualified nonphysician practitioner even if the patient is discharged from the facility on a different calendar date. Only one hospital discharge day management service is payable per patient per hospital stay.

Only the attending physician of record reports the discharge day management service. Physicians or qualified nonphysician practitioners, other than the attending physician, who have been managing concurrent health care problems not primarily managed by the attending physician, and who are not acting on behalf of the attending physician, shall use Subsequent Hospital Care (CPT code range 99231 - 99233) for a final visit.

Medicare pays for the paperwork of patient discharge day management through the pre- and post- service work of an E/M service.


E. Hospital Discharge Management and Death Pronouncement
Only the physician who personally performs the pronouncement of death shall bill for the face-to-face Hospital Discharge Day Management Service, CPT code 99238 or 99239. The date of the pronouncement shall reflect the calendar date of service on the day it was performed even if the paperwork is delayed to a subsequent date.
Christine-- Thank you very much for the information. It clarifies and helps me proceed with the appeal. Thanks again...!!
 
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