Neurology & Pain Management Coding Alert

Discharging a patient from a hospital is one of the most common scenarios you would code for your neurologist in a hospital setting. That doesn't mean you won't sometimes get tripped up by discharge anomalies.

Here are some common scenarios your neurologist could face when discharging a patient. Put these strategies to use and you're sure to bring the money in when the patient leaves.

If your neurologist finds the total discharge work to be relatively straightforward and doesn't require extended time, you'll report 99238 (Hospital discharge management; 30 minutes or less).

Example: Your neurologist admits an eight-year-old  patient suffering from new onset of seizures. The initial inpatient hospital care E/M service occurs on Thursday.The neurologist stabilizes the patient's medication and discharges the patient to his parents five days later. Your neurologist notes that the total discharge work took 15 minutes. You would use 99221 (Initial hospital care, per  day, for the evaluation and management of  a patient, which requires these 3 key components...) for the initial hospital care work and 99238 for the discharge services.

If the discharge work takes longer than 30 minutes -- perhaps because the patient is being transferred to another inpatient facility and requires extensive referral orders or to provide detailed instructions for continued home care to the relevant caregivers -- you'll instead use 99239 (... more than 30 minutes). Your neurologist needs to document the total duration of time spent in performing the final discharge services.

For inpatient hospital care services your neurologist provides to a patient who is admitted and discharged on the same date of service, you should report the observation/ inpatient hospital care E/M codes: 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date).

Caution: "You can only bill one E/M code per day," says Shelby Davidson, CPC, CMSCS, coding educator with Ohio Health. "Billing two discharge codes on the same day would be inappropriate." Therefore, you should not report a separate discharge code when using 99234-99236.

The same rule applies when one neurologist performs the initial hospital care service, for example in the morning, and a neurologist of the same group performs the discharge services later in the same date of service.

Discharge codes are time-based, not date-based, so if the patient doesn't leave the hospital on the same day your neurologist performs the discharge management services, your code choice won't change.

If the patient stays in the hospital "because the physician wanted to confirm a result before releasing, the physical discharge doesn't change the date for the services performed," says Suzan Berman, CPC, CEMC, CEDC, senior manager of coding and compliance in the departments of surgery and anesthesiology at the University of Pittsburgh Medical Center.

Pointer: CMS doesn't specifically say that the physician must see the patient on the discharge date to bill a discharge code. Chapter 12 of the Medicare Claims Processing Manual states: "The E/M discharge day management visit shall be reported for the date of the actual visit by the physician or qualified nonphysician practitioner even if the patient is discharged from thefacility on a different calendar date."

Example: Your neurologist sees an 85-year-old male who was admitted for post-traumatic seizures. He discharges the patient from the hospital on Friday but his family can't pick him up until Saturday morning. You would still report 99238 for Friday's date of service as that was the date your neurologist performed the face-to-face discharge services.

Not matching the discharge management services with the date the patient physically left the hospital may seem counterintuitive, but this is the CMS guideline, says Julee Shiley, CPC, CCS-P, ACS-AN, a coding professional in North Carolina. "As with other services, the date reported is the date performed," Shiley says.