Internal Medicine Coding Alert

Question: After a hospital inpatient recovers from an extrinsic status asthmaticus attack, the internist discharges the patient. He later develops renewed wheezing unresponsive to treatment, and the internist readmits him to the hospital. How should I report the day's E/M services?


New York Subscriber

Answer: You should code both the discharge and the admission linked to diagnosis code 493.01 (Extrinsic asthma; with status asthmaticus). Report the discharge service with 99238-99239 (Hospital discharge day management ...). For the same-day readmission, submit 99221-99223 (Initial hospital care, per day, for the evaluation and management of a patient ...) appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

You need the modifier to distinguish that the admission is a significant and identifiable E/M service on the same day as the discharge.

Be prepared: Make sure that the internist's documentation supports both the discharge and the readmission. The insurer will probably require supporting documentation before paying for both same-day services.