General Surgery Coding Alert

If your physicians aren't noting the time spent on discharges, your practice is losing out on rightful reimbursement. The solution? Educate your physicians on how their documentation affects the bottom line.

Know When Your Surgeon Can Report a Discharge Discharge services are generally bundled to surgical care, so you won't report discharge services for your surgeons in every case.

Here are the circumstances under which your surgeon can legitimately report discharge services, says Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, HIM program coordinator at Clarkson College in Omaha, Neb.
  The surgeon discharges a patient readmitted because of complications
  The patient undergoes a minor procedure (with no global period) but must be kept in the hospital due to comorbidities
  The surgeon manages a trauma patient who doesn't need surgery (or has been operated on by another surgeon) but who is under the general care of the first surgeon.

Recognize What You're Missing To reach surgeons - who would usually like to practice medicine rather than record-keeping - make documentation a dollars-and-cents issue.

Example: Medicare recognizes two codes for discharge planning: 99238 (30 minutes or less) and 99239 (more than 30 minutes). In Ohio, for instance, 99238 reimburses $69.56 and 99239 reimburses $94, for about a $25 difference.

"A lot of the doctors are spending more than 30 minutes with their patients in discharge planning, but they don't document that," says Charol Spaulding, CPC, CPC-H, vice president of Coding Continuum of Tucson, Ariz. "I have rarely seen any physicians document time on a discharge summary, even if they bill 99239."

What's included: "Discharge services" describe all services that the physician provides to a patient on the date of discharge, according to CPT guidelines. The time you count toward discharge services can include the time the surgeon spends preparing the discharge summary.

Add it up: The 30-plus minutes for discharge services don't need to be continuous. "There could be 25 minutes in the morning and 12 minutes later in the day," says Collette Shrader, compliance/education coordinator with the Wenatchee Valley Medical Center in Wenatchee, Wash. Also, the physician doesn't need to document stop and start times in detail, Shrader says. Instead, the physician can simply write down "37 minutes" without breaking down the time further. Insist on Time Documentation Many physicians simply want to bill 99238, because they don't want to bother to document time, Shrader says. And, when physicians do want to bill 99239, they sometimes don't provide enough documentation to make the code possible.
 
The good news is you can improve your coding by educating your physicians on this topic. "We have discussions with [physicians] on a regular basis," encouraging them to document time to avoid being stuck with 99238, says Jennie Horner, CPC, a coder with Southern [...]