# Pronouncement of death -E/M



## Partha (Jul 16, 2009)

*Physician does not see the patient's but only once to pronounce them deceased (check their heart, breathing, and say time of death etc.) What is the correct E/M to bill? *


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## kumeena (Jul 16, 2009)

How about 99211??


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## Gainingknowledgedaily (Jul 16, 2009)

according to WPS, MN "Only the physician who personally performs the pronouncement of death shall bill for the face-to-face Hospital Discharge Day Management Service, CPT code 99238 or 99239. The date of the pronouncement shall reflect the calendar date of service on the day it was performed even if the paperwork is delayed to a subsequent date."
I hope this helps


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## Partha (Jul 16, 2009)

Thank you!


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## RebeccaWoodward* (Jul 16, 2009)

Agreed....

*E. Hospital Discharge Management and Death Pronouncement*

Only the physician who personally performs the pronouncement of death shall bill for the face-to-face Hospital Discharge Day Management Service, CPT code 99238 or 99239. The date of the pronouncement shall reflect the calendar date of service on the day it was performed even if the paperwork is delayed to a subsequent date.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

30.6.9.2


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## LLovett (Jul 16, 2009)

*Another question on this*

What if the physician that does the discharge and pronouncement is a surgeon that did a procedure with a 90 day global period? This has happened a couple of times to my surgeons this year and I did not bill the discharge code because of the global period, but now that I think about it, I am wondering if this would even be included in a global period. It certainly is not the expected outcome. 

Any thoughts?

Laura, CPC


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## FTessaBartels (Jul 16, 2009)

*All E/M global*

If the pronouncement is within the 90-day global period it is included in the surgical fee ... all postoperative E/M related to the surgery is included.

F Tessa Bartels, CPC, CEMC


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## Gainingknowledgedaily (Jul 16, 2009)

i guess, I would look at what type of scenario you are looking at read what CMS has to say http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf 
look under K. Global Surgery


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## RebeccaWoodward* (Jul 16, 2009)

I do agree with Tessa. If the pronouncement of death is related to the surgery then it would be global.  However, if the patient expired due to another cause, unrelated to the surgery, AND the surgeon who performed the surgery happens to be the attending physician that pronounced the death, it is conceivable that he/she could bill for the discharge. I haven't had this scenario happen but I imagine it does happen. 

*CPT Modifier “-24” - Unrelated Evaluation and Management Service by Same Physician During Postoperative Period*

Carriers pay for an evaluation and management service other than inpatient hospital care before discharge from the hospital following surgery (CPT codes 99221-99238) if it was provided during the postoperative period of a surgical procedure, furnished by the same physician who performed the procedure, billed with CPT modifier “-24,” and accompanied by documentation that supports that the service is not related to the postoperative care of the procedure. They do not pay for inpatient hospital care that is furnished during the hospital stay in which the surgery occurred unless the doctor is also treating another medical condition that is unrelated to the surgery. All care provided during the inpatient stay in which the surgery occurred is compensated through the global surgical payment.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

30.6.6

Not my carrier, however....

Q-Is the discharge day 99238 included in the global package if the surgeon is also the attending physician?

A-Yes. The CMS Online Manuals, Pub. 100-4, Chapter 12, Section 30.6.6 provides the guidelines regarding payment of evaluation and management (E/M) services provided during the global period. This section advises that E/M services provided during the postoperative period of a surgical procedure, furnished by the same physician who performed the surgical procedure is eligible only when billed with modifier -24. The service; however, must be supported by documentation that indicates that the service is not related to the postoperative care of the procedure. This section also advises that we do not pay for inpatient hospital care that is furnished during the hospital stay in which the surgery occurred unless the doctor is also treating another medical condition that is unrelated to the surgery.

http://www.highmarkmedicareservices.com/faq/partb/pet/lpet-discharge_day_management.html#2


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## LLovett (Jul 17, 2009)

Interesting.

I appreciate the responses. It looks like I was right to not bill those discharges. 

I think it would be really hard to determine if the death was related to the surgery or not for the surgeons I have this issue with. The patients this happened with were going to die with out surgery, no question about it. The surgery is done and they end up in ICU for a few days, go back for a couple more procedures and then ultimately there is nothing the doctors can do. The one that I remember clearly was multiple organ system failure.

Again thank you for responding it was very helpful,

Laura, CPC


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