Advanced Search

Cardiology Coding Alert

Reader Question:

Billing When Patient Leaves AMA

Published on Wed Aug 01, 2001

Question: If a patient leaves the hospital against the physicians medical advice, can the physician still bill for a discharge service?

Colorado Subscriber
 
Answer: According to CPT, hospital discharge codes 99238 (hospital discharge day management; 30 minutes or less) and 99239 (... more than 30 minutes) are to be used to report the total duration of time spent by a physician for final hospital discharge of a patient. The codes 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.
 
In the case of a patient who leaves the hospital AMA (against medical advice) without seeing a physician, such services have not been rendered, and therefore no discharge should be claimed, says Martha Gerant, CPC, a practice coder with Cardiology Services, an 11-physician practice in Shawnee Mission, Kan.
 
In addition, Gerant notes, to bill for a hospital discharge appropriately, the cardiologist must have spent face-to-face time with the patient, which does not occur if a patient leaves AMA. If the cardiologist saw the patient on the same day prior to his or her departure from the hospital, however, the appropriate code for subsequent hospital care (99231-99233) may be billed.
 
If the patient leaves the hospital AMA but sees a physician, a discharge E/M service may be billed. For example, says Marko Yakovlevitch, MD, FACP, FACC, a Seattle cardiologist, the patient may inform the physician that he or she is leaving. After unsuccessfully trying to persuade the patient to stay, the cardiologist may inform the patient about medications and otherwise counsel him or her. The patient will also be asked to sign a form acknowledging the AMA departure. In such cases, the E/M provided may be even more extensive than that provided for a discharged patient who remained in the hospital according to the physicians instructions.

Other Articles in this issue of

Cardiology Coding Alert

View All