Internal Medicine Coding Alert

Question: An internist discharges a patient from the hospital and then admits him to a nursing facility. The physician did not go to the NF for this admit or perform a follow-up. Should I charge an NF visit?


Washington Subscriber

Answer: No. You should only code the hospital discharge (99238, Hospital discharge day management; 30 minutes or less; or 99239, ... more than 30 minutes).

The nursing facility admission (99304-99306, Initial nursing facility care, per day, for the evaluation and management of a patient ...) requires a face-to-face physician-patient encounter at the facility.

Tip: Checking the place of service will help you recognize whether an NF service deserves coding. POS codes must match billed service codes. You have to use 99304-99306 with POS 31 (Skilled nursing facility) or 32 (Nursing facility), and 99238-99239 with 21 (Inpatient hospital). If the internist was never in POS 31-32, you cannot charge for any services. 
 
Answers to You Be the Coder and Reader Questions answered/reviewed by Vicky V. O'Neil, CPC, CCS-P, coding and compliance educator in St. Louis, Mo.; Kathy Pride, CPC, CCS-P, director of consulting and training for QuadraMed in Reston, Va.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.