Neurosurgery Coding Alert

Question: Can our surgeon file a claim for pronouncing a patient dead? This sometimes requires a lot of work, but we're not sure how to be reimbursed.


Washington Subscriber

Answer: You may be able to charge for a death pronouncement, depending on your carrier.

At least one Part B carrier in Washington, Regence Medicare, said a year ago that it was "inappropriate" for physicians to use a discharge code to bill for filling out a death certificate. But carriers in other areas disagree.

For instance, physicians can bill for "reasonable and necessary medical services rendered up to and including pronouncement of death," according to a new FAQ posted on CIGNA Medicare's Web site. Physicians can bill hospital discharge codes 99238-99239 (Hospital discharge day management ...) and other codes, as appropriate.

CPT guidelines (although not universally followed) state clearly that pronouncing a patient dead can count as a discharge summary. For instance, you could report a discharge code for more than 30 minutes (99239) or for 30 minutes or less (99238), depending on how long the service takes. As an attending diagnosis, you could cite V68.0 (Issue of medical certificates), in addition to the cause of death.

You can also bill separately for any other services the physician provides prior to the patient's death, such as CPR or cardiac shock. 

If a patient arrives at the emergency department already dead, coding is less certain. Frequently, the patient will go directly to the coroner after being declared dead. In some cases, however, the emergency physician will perform a detailed examination of a DOA patient to identify the specifics of trauma. The physician may also take a history from a family member.

Often, hospitals will ask the physician to refrain from billing for these services. Charging a grieving family for a death pronouncement can have a disastrous effect on patient relations.