Internal Medicine Coding Alert

Question: When an internist discharges a patient from a hospital and admits him to a nursing facility, should I code both services?


Iowa Subscriber

Answer: Yes. You should report the hospital discharge (99238-99239, Hospital discharge day management ...) and the nursing facility care admission (99304-99306, Initial nursing facility care, per day, for the evaluation and management of a patient ...).

Myth: Because you shouldn't code a same-day nursing-home discharge and a hospital admission, many internists assume the converse is true. But CPT specifies that you may report a same-day hospital discharge and nursing facility admission. "Hospital discharge services performed on the same date of nursing facility admission or readmission may be reported separately," according to CPT's "Initial Nursing Facility Care" introductory notes.

Medicare also supports this guideline. Section 15505.2B of the Medicare Carriers Manual instructs the carrier to pay both the inpatient discharge and the nursing home admission on the same day.

Key: The internist must document the hospital discharge and nursing facility admission as two distinct services. Codes 99238-99239 and 99304-99306 require different elements. For instance, hospital discharge codes "include, as appropriate, final examination of the patient, discussion of the hospital stay ... instructions for continuing care to all relevant caregivers and preparation of discharge records, prescriptions and referral forms," states CPT's notes on "Hospital Discharge Services."

On the other hand, initial nursing facility care code 99304 requires a detailed or comprehensive history, a detailed or comprehensive examination, and straightforward or low-complexity medical decision-making.

Answers to You Be the Coder and Reader Questions answered/reviewed by Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., a healthcare consulting firm based in Landsdale, Pa.; Kathy Pride, CPC, CCS-P, a coding consultant for QuadraMed in Port St. Lucie, Fla.; and Bruce Rappoport, MD, CPC, an internist and consultant for Rachlin, Cohen & Holtz LLP in Fort Lauderdale, Fla.