# Billing discharge code the day prior to actual discharge



## melissatwy (May 19, 2010)

If I see a patient today and make all discharge arrangements, dictate the summary, write the scripts in preparation for patient to be discharged tomorrow, can I submit a 99238 for today and then my partner submit a subsequent visit code (231-233) for tomorrow when he sees the patient and writes the actual discharge order?


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## fcallahan (May 19, 2010)

That will be a "NO".
That procedure code is 'linked' to the date of discharge.
Once you dictate that discharge summary, that is it. Nothing else.
You charge a discharge the day of not the day before discharge, you can't do that.
Your partner doesn't get paid for writing orders.

Look at the description of the procedure code.  There must be certain components Chief Complaint, History of Present Illness, PFSH, Assessment and Plan.  

Writing orders don't give any of these components.  You have already done the work..

If that is a discharge procedure code then why would your partner be following up with your decision to discharge?  Why don't you just go ahead and discharge her?

If your partner sees this patient again the next day using a susbsequent procedure code.  Your claim will probably get denied.


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## jek521 (May 20, 2010)

I disagree with this response, as our Hospitalist service often bills a discharge day code followed by a subsequent visit code.  This has been the clear instruction of our carrier, WPS Medicare:

_Q3. I provided the final discharge instructions on Tuesday. However, the patient did not leave the hospital until Wednesday. I did see the patient on Wednesday. How do I bill for this? 
A3. Report the discharge day management service for the date of the actual visit, even if the patient is discharged from the facility on a different calendar date. The service on Wednesday is a subsequent hospital visit code when the documentation supports the code and the level of service and medical necessity of the service. _
http://www.wpsmedicare.com/part_b/education/2009_0629_emfaqdischarge.shtml
The "subsequent visit after discharge" still should be medically necessary.  Are there minor changes in the patient's condition?  Is the discharge is contingent upon an outstanding lab or opinion from a consultant?  I commonly see that the "subsequent" day visit is to confirm that discharge is appropriate or the discharge orders are tweaked a little.  (Of course, I've also seen documentation of patients who severely declined & discharge is canceled.)
I suggest checking with your carrier/MAC to see if they offer any guidance.  Many of our major commercial payers state that they follow Medicare rules.

Jen
PS--our claims get paid, too!


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## kellyross (May 20, 2010)

I agree with 2nd response.  I think the doctor had the right expectation of being paid for the discharge planning, but got caught up in the term "discharge" - when actually that would be subsequent care prior to discharge.  The only person entitled to bill the actual discharge on the day of discharge is the physician that was face - to - face with the patient and yes, included in that discharge - they would be paid for writing orders.

An order to discharge and an actual "encounter" with a patient are two very different things. 

The question, i feel - was just worded backwards.


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## LindaEV (May 20, 2010)

I agree with second response as well. Bill the date the service was provided.


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## melissatwy (May 21, 2010)

Thanks for your help!


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