# Discharge, Critical Care & Prolonged Care



## jifnif (Apr 6, 2010)

I have a discharge note, a critical care note and prolonged care on the discharge.  Can I accummulate all time (it is documented and charge a discharge with prolonged care?  Is this the best way to do this?


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## FTessaBartels (Apr 6, 2010)

*No prolonged with discharge*

You cannot bill prolonged service with discharge day management codes.  99239 covers ALL the time spent if you spend 31 minutes or more. 

F Tessa Bartels, CPC, CEMC


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## jifnif (Apr 7, 2010)

Thank you.  What do you do in that situation?  Do you bill the higher paying code such as a critical care and n/c the d/c?


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## daniel (Apr 7, 2010)

Based on what you wrote.

Sounds like the patient wouldn't of been a critical care service if the patient was dischared that day.

So if this is so, stick with the discharge code.

But if the patient was provied with critical care and then expired.

Stick with the critical care charge as long as it's documented as such.
You could bill either the discharge or CC in this case, but I suggested the CC instead because it reimburses higher.

Daniel


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## jifnif (Apr 7, 2010)

Thanks, i will code the cc due to pt was discharged to home but he did have respiratory failure.  Unfortunately this pt is going home to expire.  Thanks.


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## FTessaBartels (Apr 7, 2010)

*You can code both*

You can code both, though this is a highly unusual situation.  You will need a -25 modifier on the critical care code. 

Once the decision has been made to D/C the patient home to expire, you are *no longer providing *critical care. You are *not* making any additional efforts to reverse the patient's decline, support vital system function(s)  and/or prevent further life threatening deterioration of the patient's condition. (See definition of Critical Care Services in 2010 Professional edition CPT, page 20.) 

I realize the physician probably did spend a lot of time coordinating ambulance transfer, home hospice care, etc. Unfortunately all that time is part of 99239.

I'm sure this is not what was meant, but you cannot simply lump all the time into the critical care codes just because they pay better. 

Be prepared to get a denial and to have to appeal with your excellent documentation. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## daniel (Apr 7, 2010)

So you say you can code both. CC and discharge.

Makes sense, but do have a article or something that says this in writting.

Interesting, I posted this question before and had no luck with a sufficient answer.


As for your answer of using a discharge vs CC.

Were both correct, my stance is if the day started off as Critical Care then later in the day the decision was made to take the patient off supportive care to comfort care by the family and released home.

Then you should code for just the CC without inclusion of the discharge time.


Daniel


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## jifnif (Apr 8, 2010)

I coded CC on the basis that I have two separate notes.  The CC note has documented time to support time spent in critical care.  Documentation on the discharge note states up until the patient leaves the hospital they will be tending to this vent depend pt and that the pt's parents understand the outcome of taking the pt out of critical care.  There is time on this note also documenting critical care.  I believe this specific scenario is a unique one and I am billing based on the work I have documented by physician, not based on what will pay higher.  I just wanted to figure out how to correctly bill so the physician would be reimbursed for the amount of complex time was spent with this patient.  I have sent w/ notes as it is keystone mercy.  We'll see.  Perhaps I should have not billed for prolonged time on top of the critical care?  Like I said though, the discharge note supported critical care up to the time of patient's discharge.


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## jdibble (Oct 6, 2010)

My Hospitalists asked a similar question about billing both CC and Discharge, so I would just like a clearer answer on this...

Can you bill both CC and a discharge in a case where the patient was seen by the Hospitalist for CC during the day and then later the decision to transfer the patient to another facility has been made and the hospitalists discharges the patient.  The hospitialist has provided the CC and has documented this and then writes a discharge summary for the discharge.  Are these both billable?  And if not, wouldn't we charge for the critical care rather than the discharge - since most of the work the physician provided was for the CC of the patient?

Also, to clarify another question - if a patient is being admitted to ICU and is already in a critical state, would the doctor do an H&P for the admit and then a CC note for the care above the admit and bill both those codes?

Thanks for the help to clarify this for me!


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## kcashe1477 (Feb 17, 2011)

FTessaBartels said:


> You cannot bill prolonged service with discharge day management codes.  99239 covers ALL the time spent if you spend 31 minutes or more.
> 
> F Tessa Bartels, CPC, CEMC


Just wanted to clarify that prolonged visit codes are not billable with discharge day management codes. In my case, our internal medicine physician discharged a pt from a skilled nursing facility so billed a 99316 and also 99356 + 99357 prolonged svc codes. I'm not so sure about these prolonged svc codes because the 99316 discharge is already a time-based code. So could you please advise me on this situation and if there is any other alternative options for the physician to get credit for his documented time?

I would appreciate your help with this.

Thanks,
_kcashe1477@yahoo.com_


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## FTessaBartels (Feb 18, 2011)

*No Prolonged service*

The prolonged service codes do NOT apply to discharge day management codes. DC management is either 30 minutes or less, or it is more than 30 minutes.  Whether you spend 31 minutes or 3 hours and 30 minutes, it is still coded as 99316. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## kcashe1477 (Feb 21, 2011)

Thank you for clarifying this for me.


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