# discharge day management



## carlybear1 (Apr 18, 2013)

Hi all! Any help and documentation that can answer this will be very much appreciated!!

Our hospitalist completes all necessary documentation and dictation for a discharge and conducts a face-to-face encounter with the patient. (Day 1) But then the discharge gets delayed, the patient is still in the hospital and the hospitalist visits the patient the next morning due to medical necessity, then the patient is D/C'd later that day.(Day 2)

I know we should bill the discharge day management code on the day of the initial face-to-face encounter with the patient.( Day 1). But…Can we code a subsequent hospital visit for the next day if medical necessity is metL (Day 2) 

Thanks!!!


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## airart (Apr 22, 2013)

*Discharge or Leave of Absence calculation*

I would refer to Chapters 3 and 6 of the claims processing manual from Medicare.  They define what is considered a “true” discharge day and what is not.  From what you described the patient wasn't discharge if they were still in-house more than 24 hours.

Link: (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html)

Choose Option:

100-04
Medicare Claims Processing Manual


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## Pam Brooks (Apr 22, 2013)

The guidance says that you must bill out the discharge day management code for the actual date of service that the discharge service was provided/documented. Hosptialists and other attending providers do this service the day before simply as a matter of convenience....with the plan that the patient goes home without incident the next day. So, if that happens, there is no billable service for the following day. Look at 
*30.6.9.2 - Subsequent Hospital Visit and Hospital Discharge Day Management (Codes 99231 - 99239) *
*(Rev. 1460, Issued: 02-22-08, Effective: 04-01-08, Implementation: 04-07-08) *

We've discussed this at length with our provider reps at NHIC, and this is their advice: If the patient's discharge is delayed due to an exacerbation, new problem, complication, or whatever, we ask the provider to document that circumstance in a way that clearly indentifies the delayed discharge, we convert the discharge into a round, and then ask for a new discharge summary when the patient actually does go home.


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## airart (Apr 23, 2013)

*Disharge Day Management*

I understand it can be very frustrating when you have cases that fall into the grey matter.  I have come across those myself from time to time.  I found this on Novitas Solutions website regarding Discharge Day Management FAQs.

1.   How do I bill a discharge day management code when I discharge my patient on day one, but dictate my notes on day 2? Which day do I use for submitting the claim?

The discharge day management service is billed under the actual discharge date. The medical records should clearly state the date of the actual discharge, and also indicate that the dictation was made on the following date.

Link:  https://www.novitas-solutions.com/faq/partb/pet/lpet-discharge_day_management.html#1

According to the above question you bill the discharge day management code on the day the face-to-face is given on regardless if they are actually discharged from the facility or not on the same day.  As long as its documented in the chart all should be well.


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