Internal Medicine Coding Alert

Question: I saw a patient in the hospital and coded 99233 (Subsequent hospital care ...). Some of the patient's problems were addressed by consults, and later in the day her condition stabilized. A bed became available in a skilled nursing facility (SNF), and I returned to the hospital to arrange discharge. All of this happened on the same day. Can I bill the hospital discharge code 99238 in addition to 99233, or am I restricted to using just 99238 because I discharged the patient the same day?

Ohio Subscriber

Answer: You can bill only one hospital code: 99238 (Hospital discharge day management; 30 minutes or less). CMS addresses this in the Medicare Carriers Manual, section 15505.2, stating, "Pay only the hospital discharge management code on the day of discharge. Do not pay both a subsequent hospital visit in addition to hospital discharge day management service on the same day by the same physician."

Medicare considers all work performed by the physician on the discharge date "rolled" into the discharge. The time you spend with the patient on the date of discharge does not have to be continuous.

If you are the physician admitting the patient into the SNF, you may also be able to bill for 99303 (Evaluation and management of new or established patient involving a nursing facility assessment at the time of initial admission or readmission to the facility). (For more detail on coding nursing home admissions and visits, see article in the May 2002 Internal Medicine Coding Alert.)

Answers to You Be the Coder and Reader Questions were provided by Kathy Pride, CPC, CCS-P, HIM applications specialist with QuadraMed, a national healthcare information technology and consulting firm based in San Rafael, Calif.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for RCH Healthcare Advisors LLC, a Fort Lauderdale, Fla.-based healthcare consulting company.