Cardiology Coding Alert

When you code discharges for patients who have had cardiac diagnostic procedures done in the hospital, your chances of receiving full reimbursement are greater if the cardiologist's discharge-report documentation details the total time he or she spends on the day of discharge providing the discharge services. You should code hospital discharges with 99238 (Hospital discharge day management; 30 minutes or less) or 99239 ( more than 30 minutes), depending on the length of time it takes to provide services. CPT specifies that you should use 99238 and 99239 for "all services provided to a patient on the date of discharge, if other than the initial date of inpatient status."

For inpatients admitted and discharged on the same day, you should use 99234-99236 for observation or inpatient hospital care, "including the admission and discharge of the patient on the same date."

Coders sometimes have problems with 99238 and 99239 because CPT lacks clarity regarding several aspects of the codes' descriptive information. CPT states that 99238 and 99239 include "as appropriate, final examination of the patient, discussion of the hospital stay, even if the time spent by the physician on that date is not continuous, instructions for continuing care to all relevant caregivers, and preparation of discharge records, prescriptions and referral forms." Don't Forego Face-to-Face Meetings The following scenario may be familiar for many cardiology coders: A cardiologist gives a discharge order for a patient, then talks to the nurses and dictates the summary but does not conduct an actual patient exam before the patient leaves the hospital. The question for coders is whether they should bill 99238 or 99239 if the cardiologist has no face-to-face encounter with patient.

Although CPT does not directly state that face-to-face encounters are necessary during discharge allowing physicians to determine whether such encounters are "appropriate" the guidelines imply that physicians should meet with patients as part of the discharge process.

Face-to-face contact with patients is inherent in all E/M codes, including discharge summaries. Consequently, cardiologists should show in their discharge reports that they were physically in the room with the patient, coding specialists advise. Indeed, the whole issue of face-to-face encounters with physicians during discharges is controversial, says Catherine Brink, CMM, CPC, president of Healthcare Resource Management of Spring Lake, N.J. Consult your carrier if you're not sure about face-to-face exam requirements, Brink says. For instance, Xact Medicare Services, one of Pennsylvania's Medicare payers, requires a face-to-face encounter for discharge services, she adds. Although seeing your patient prior to discharge may be the best practice, it is not the only deciding factor for billing 99238 and 99239, says coding consultant Charol Spaulding, CPC, CPC-H, vice president of Coding Continuum Inc. of Tucson, Ariz. Physicians may use [...]