# Discharge services



## AmandaW (Dec 2, 2014)

Is the discharge service reserved for the admitting Dr only or can any of the Drs that see the patient during a hospital stay discharge them?  

One example that we have come across is that our hospitialist admitted and saw a patient for chest pain along with diabetes, hypertension, etc. (but the main reason for the admission was the chest pain).  He consulted the cardiologist-cardio saw the patient and then both the cardio dr and the hospitialist dr billed a discharge service.  Ours (the hospitialist) discharge got to the insurance first therefore was paid on.  
The insurance received a billed discharge service a little later from the cardiologist, recouped our money and is paying the cardio dr.   

Should we appeal that?


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## cjhalk@yahoo.com (Dec 2, 2014)

I thought for sure there would be a solid answer online, but I was surprised there was not. Here is the best article I found. It doesn't cover your example exactly, but it does answer your question in the last paragraph. This is from Supercoder - Published on Fri, Feb 01, 2002 - Gastroenterology Coding Alert.
Here is the link - https://www.supercoder.com/coding-n...e-coder-different-physician-discharge-article.

Thank you for posting this question. I learned something from my research. 

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Question: Dr. A fills out the discharge forms for a patient who is expected to be discharged Friday. It turns out the patient is discharged Saturday, and the discharge is handled by Dr. B, the attending physician that day. Who should bill for the hospital discharge, and what does the other doctor report?

Minnesota Subscriber

    Answer: Dr. B should bill for the discharge (99238-99239) since he or she was the one who was actually present and prepared the patient's discharge, according to Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa. The hospital discharge codes are used to report all services provided to a patient on the day of discharge. These are time-based codes and may include services such as the final examination of the patient, instructions for continuing care and the dictation of discharge records. 

Although Dr. B may reference Dr. A's original notes and append them to the final discharge records, he or she will be the one to explain why the patient was discharged a day later. Dr. B will also have to provide the necessary documentation to support the medical necessity for the extra day stay. 

Dr. A may bill for the subsequent hospital-care visit (99231-99233) if appropriate and medically necessary for his or her visit on Friday. These are not time-based like the discharge codes, but are dependent on the level of history, examination and medical decision-making that occurred on the day before discharge. 

The tricky part in this is getting paid. CPT does not specify that the admitting physician must be the one to do the discharge. According to the American Medical Association publication Principles of CPT Coding, attending physicians may use the hospital-discharge services codes (99238-99239). In practice, however, Medicare and other payers have been known to deny the hospital admission and entire hospital stay if anyone other than the admitting physician performs the discharge. Your practice needs to talk with the payer to determine its particular policy.


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## OCD_coder (Dec 3, 2014)

The following information might be helpful as you appeal.  This is Medicare's rules, so the carrier you are dealing with may have different rules.  

Q2. The surgeon admitted the patient for surgery. However, due to a change in the patient's condition, the internist followed the patient and wrote the discharge orders. Who can bill the discharge? Is this a transfer of care?

A2. CMS IOM Publication 100-04, Chapter 12,, Section 30.6.9.2 B, discusses the discharge visit and states, "Only the attending physician of record reports the discharge day management service. Physicians or qualified non-physician 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."


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## AmandaW (Dec 3, 2014)

Thank you guys SO much!!


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## jdibble (Dec 3, 2014)

I agree with the Medicare statement that the "admitting" doctor is the only one who can discharge the patient. However, just to clarify this, as in a group of Hospitalists for example, it does not have to be the acutal physical admitting doctor, but another physician from that group can do the discharge.


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## AmandaW (Dec 5, 2014)

Oh yes, for sure Jodi.


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