EM Coding Alert

Don’t miss out on reimbursement by not reporting 99238.

Whether or not you are able to bill for your physician’s time spent on death pronouncement, depends on when the patient dies and your provider’s notes after face-to-face hospital discharge day management service(s) are performed. 

These services can be a substantial amount of work. Continue reading to learn how you can code to ensure your provider gets paid for that work.

Coding for DOA Isn’t Cut and Dry

For providers that work in emergency room settings or other locations where a patient might be dead on arrival (DOA), your challenge is determining whether the services the doctor performs are actually billable and if so, what procedure code you should use. 

The answer to what procedure code should be used with a DOA is all over the board, says Charlotte T. Tweed, RHIA, CPC, coding auditor, GME interim compliance manager/privacy officer and certified ICD-10 instructor at the Florida Hospital Graduate Medical Education Department of Coding & Auditing in Orlando. 

“Medicare certainly recognizes a physician must pronounce and should be paid for that service along with the work involved with the family and death certificate,” Tweed adds. “[The] AMA also agrees with that policy. Generally an ED E/M service would be charged for the service. What that level should be varies greatly depending upon who you speak to and how you would score the MDM/medical necessity.” 

Charge for Face Time with Deceased

If your physician has face-to-face time with the deceased patient and sets the time of death, whether it’s after she attempts resuscitation or not, you will submit one of two discharge codes: 99238 (Hospital discharge day management; 30 minutes or less) or 99239 (… more than 30 minutes). 

Note: You can charge for face-to-face time with a living or DOA patient.

Example: Emergency Medical Services (EMS) provides cardiopulmonary resuscitation (CPR) on route to an operating room. Your physician is asked to go to the OR to provide discharge management and when he gets there, he relieves the EMS and continues the CPR. After finding no pulse or heart sounds, the doctor calls the code and pronounces the patient dead. You would use either discharge code 99238 or 99239 and 92950 (Cardiopulmonary resuscitation [eg, in cardiac arrest]) for the CPR.

Important: “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,” says CMS in transmittal 1460. Take a look at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1460CP.pdf to read the transmittal in its entirety.

Some providers are hesitant to charge for this face-to-face time, but there is work that deserves reimbursement, often including an examination, calling the code, and pronouncing the patient. 

Tip: The pronouncement of death prepared by the physician who pronounces the patient is key when it comes to coding a discharge.

Some facilities online charts consist of “death notes” that include a final weight, diagnoses, and codes as a clinical picture leading up to the death, the time of death, and whether there will be an autopsy,” explains Dawn J. Lafferty, MPA, CMRS, CRA, RMA, faculty at Bryant and Stratton College in Rochester, N.Y.

“At the time of death, the provider needs to write a progress note for pronouncement of death,” John F. Bishop, PA, CPC, CPMA, CGSC, CPRC, director surgical coding and auditing services, senior multispecialty coder, auditor and educator at The Coding Network, LLC in Tampa, Fla. “This note can be treated as the hospital discharge day management.”

Recognize That DOA May Mean No Codes

If your provider truly did not perform any work on the patient because she was dead upon arrival, you may not be able to report the service.

Example: EMS brings a patient to the ER and one of your providers is asked to provide a “death summary.” The physician finds no spontaneous respirations, pulse, or heart sounds and pronounces him dead and sets the time of death. You should not code or bill this service. It’s important to not only understand what transpired during the time with the patient, but the documentation should also indicate what support, if any, was provided to the patient upon arrival.

Look at the Money Side

If you skip billing for your provider’s death pronouncement services, you are leaving money on the table that your physician deserves. 

Calculate the fees: Multiply the relative value units for 99238 by the national conversion factor to get the cost of the procedure. 

• CPT® code 99238 relative value units = 2.03
• Multiply 2.03 x 35.8228 (national conversion factor) = $72.72

So if your provider performed services and you didn’t report 99238 for his work, you cost your provider $72 per encounter. Over time that could add up to lots of lost revenue.