# Discharge and admit



## Gemini18 (Mar 31, 2009)

This is a headache, so forgive me if it gives anyone else one.

I have a pt who was *Discharged* by Dr. A on 11/02/08.  On 11/6/08 returned to the hospital for the same reasons and was seen by Dr. B (of the same group), pt was *discharged* on 11/9/08.  What would the second admit and discharge be?

I am confused?


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## ARCPC9491 (Mar 31, 2009)

Dr. A would bill the discharge on 11/2/08, 99238 or 99239.

Dr. B would bill admission, 99221-99223 on 11/6/08 and 99238 or 99239 on 11/9/08

Right? or did I read that wrong?


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## renifejn (Mar 31, 2009)

I thought the same thing when I read it, AR


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## Gemini18 (Mar 31, 2009)

*Thanks*

Thank you AR so much -

I keep getting these kinds of charts and I get confused every time.

LOL


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## Gemini18 (Mar 31, 2009)

Is there anything in writing I could download to keep for my records regarding  a discharge then and admit?


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## ARCPC9491 (Mar 31, 2009)

This might help..........

Report a hospital discharge services code (CPT 99238-99239) for patients who are discharged from inpatient status on a day other than the day they are admitted.


The following scenarios help illustrate how you should use these codes:

Scenario one. You decide to keep a patient for observation on a Tuesday. You initiate the observation, supervise the observation care plan and periodically assess the patient. On the following day, you decide the patient is well enough to go home. You discuss the patient's stay, give instructions for ongoing care and prepare discharge records. The patient is released from the hospital altogether. You should report an initial observation care code, CPT 99218-99220 for Tuesday, and an observation care discharge service, CPT 99217, for Wednesday. 

Scenario two. You keep a patient in the hospital for observation on a Tuesday. You perform the same services relating to the initiation of observation status as described in scenario one. Later that day, you determine that the patient is well enough to be released and you furnish the same discharge services described in scenario one. You should report an observation or inpatient care service (including admission and discharge services), CPT 99234-99236, for that day. 

Scenario three. You admit a patient as an inpatient on a Tuesday. You take the patient's history. You provide an examination of the patient that involves some level of medical decision-making (for example, you provide an initial hospital service, CPT 99221-99223). You check on the patient later in the day and decide he or she is well enough to be discharged. You do a final examination of the patient, give instructions for continuing care, prepare discharge records and write the patient a prescription (for example, you provide a hospital discharge service). The patient is discharged from inpatient status on the same date as the admission. You should report an observation or inpatient care service, CPT 99234-99236, for that day. 

Scenario four. You admit a patient as an inpatient on a Tuesday. You provide an initial hospital service as described in scenario three. During your rounds on the following day, you determine the patient has improved enough to be released. You perform the hospital discharge service as described in scenario three. The patient is discharged from inpatient status a day after the admission. You should report an initial inpatient service, CPT 99221-99223, for Tuesday, and a hospital discharge service, CPT 99238-99239, for Wednesday.


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## FTessaBartels (Mar 31, 2009)

*What is confusing you?*

Gemini,

You have the correct answer already (thanks, AR).

But, what is it, exactly, that is confusing you?  Maybe if we understand your dilemna a bit better we can give you more generic help so you won't feel confused in the future.

F Tessa Bartels, CPC, CEMC


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