# Subsequent Hospital code after a discharge code



## karenpez (Oct 29, 2013)

Here is my scenerio:
This is a hospitalist group of physicians.  Dr. A completes a discharge summary and bills a 99239 on Monday and goes home for the day thinking this patient is leaving the hospital for hospice care.  Due to patient not leaving on Monday, Dr. B sees the patient on Tuesday and completes documentation to support a subsequent visit (99232).  Can Dr. B bill this subsequent visit 99232 after the 99239 discharge code has been billed?  
Thanks in advance for any help!!!


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## MikeEnos (Oct 29, 2013)

My advice would be not to bill the discharge, since they weren't discharged.  That way Dr. B can still bill for his inpatient follow-up.  Depending on the work Dr. A did, perhaps his encounter can be billed as an inpatient follow-up as well.


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## Pam Brooks (Oct 30, 2013)

It's my understanding that the 99238/9 is to be billed on the day the face-to-face happened and for which the discharge summary was created.  Occasionally, the patient will be held over for a medically necessary reason....lab results, fever, etc, and not discharged until the following day.  In that rare instance, it is (according to our contractor) appropriate to bill the subsequent visit code.   If the patient is held another day for a non-medically necessary reason, such as they don't have a ride, then that day should not be billed at all.  From NHIC:  

"Hospital discharge day management services, CPT code 99238 or 99239, are a face-to-face 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 NPP 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 NPPs, other than the attending physician, who have managed 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."

Having said that, our contractor is now NGS, as of 10/25 and we're looking to see if they have a similar policy.


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## bo (Apr 17, 2015)

Scenario, physician has discharged the patient to a SNF.  However,  because the SNF does not have a bed until the next day, can the physician bill for a hospital visit until there is a bed ready?


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## TTcpc (Apr 20, 2015)

bo said:


> Scenario, physician has discharged the patient to a SNF.  However,  because the SNF does not have a bed until the next day, can the physician bill for a hospital visit until there is a bed ready?





Hello,

There is no medical necessity for the continued billing of visits in this case.  Our group has been instructed to do the discharge summary/bill on the day that the patient is medically cleared for discharge and for subsequent days we have a dummy code that we created to track how many "social" (meaning the hospital requires them to round on the patient every day that they are in the facility, but no medical necessity for the visit) visits they are having to do to account for their productivity.  However, if something comes up and the patient has an event happen that would create the medical necessity of an inpatient stay once again, you could resume billing.


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