Internal Medicine Coding Alert

Question: When one doctor in a group discharges a patient to a nursing home from the hospital and, within 24 hours, another physician from the same group discharges the same patient from the nursing home, can both physicians report a discharge on the same day?

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Answer: The first physician is entitled to bill discharge day management (99238-99239) for his services in discharging the patient from the hospital, as well as the evaluation and management services for admitting the patient to the nursing home (99301-99303), says Jeanne Fitzgerald, CPC, an independent coding consultant in Ann Arbor, MI. CPT and Medicare rules permit separate reporting of inpatient discharge day management and nursing home admission on the same day.

This scenario is unusual, but if the patient were admitted to the nursing home with the intention of keeping her there, and for an unforeseen reason she had to be discharged the same day, the second physician may then bill for the discharge of the patient using nursing home discharge day CPT codes 99315-99316. If this is a Medicare patient, we would suggest that Physician No. 1 use modifier -25 on the nursing home admission code to assure that separate payment is forthcoming for those services.

Julie Painter, CPC, a coding specialist with Physician Reimbursement Systems in Denver, CO, agrees that both physicians should be able to bill for the discharge.

However, she does note that the payer might have a problem understanding how the first physician decided that the patient should be cared for in a nursing home, and then later, the same day, the patient was deemed well enough to be discharged home.

As long as they can include sufficient documentation, then they should both be able to bill for the discharges, she says.

Editors note: If this same scenario had occurred between inpatient facilities (such as two hospitals instead of a hospital and nursing facility), the second discharge day management code would not be billable. If an admission and discharge to a hospital occur on the same day, regardless of the admission status, you cannot bill for both services on the same day, as they are both included in a single CPT code. There are different rules for nursing homes and hospitals regarding admission and discharge on the same day.