EM Coding Alert

Question: We had a trauma patient come to our hospital. One of our providers saw the patient and pronounced him dead. How do I charge for my provider’s service? Her documen­tation summarized what happened from the time of the accident, the ride to the hospital, and what happened in the trauma area. She did a brief examination prior to the pronouncement, but the helicopter/emergency room (ER) crew did most of the work. The documentation doesn’t support a consult. I’m at a loss. Any ideas?

California Subscriber

Answer: Medicare does not designate specific codes for death pronouncement, but its rules dictate that in this case, it would be appropriate to report either 99238 (Hospital discharge day management; 30 minutes or less) or 99239 (Hospital discharge day management; more than 30 minutes).

You would choose 99238 if the physician spent 30 minutes or less with the patient and 99239 if the physician spent more than 30 minutes with the patient. Remember, only the physician who actually makes the death pronouncement can bill for these face-to-face hospital discharge codes.

Also, if the physician provided other services for the patient before he died, such as cardiac shock treatment, you can bill separately for those services when submitting the discharge code. Make certain the diagnoses for each service are clear and supported within the documentation of the discharge (pronouncement).

Important: You must report the date of service as the date the physician pronounced the patient dead, not when the paperwork was finished.