General Surgery Coding Alert

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 Ohio Medical Center in Portsmouth Ohio. Horner tells physicians that "over a period of time, it really does add up, and they're doing work they're not getting paid for properly."

Next Month: More discharge coding pitfalls to avoid.