Oncology & Hematology Coding Alert

Question: Our oncologist discharged a patient from the hospital. He told us he spent at least an hour during the discharge, but we don’t have any time at all listed in the record. What should we do?

Codify Subscriber

Answer: When your physician performs hospital discharge services, you have two codes as options, as follows:

• 99238 — Hospital discharge day management; 30 minutes or less
• 99239 — ... more than 30 minutes.

As the code descriptors indicate, the choice between the two codes depends on the time your provider spends on the discharge services. Unfortunately, if there is no time notation in the discharge service documentation, you must code 99238 rather than 99239.

In black and white: “Hospital discharge day management codes 99238 and 99239 are time based so it is imperative that medical documentation reflect total time spent by a physician during the discharge of a patient,” Part B MAC Novitas Solutions says in its Discharge Day Management educational Q&A. “The codes include, as appropriate, final examination of the patient, discussion of the hospital stay, even if the time spent by the physician on that date is not continuous, instructions for continuing care to all relevant caregivers, and preparation of discharge records, prescriptions and referral forms.”

By failing to document the time spent in discharge, the physician forfeited $35 — that’s the difference between the payment of about $74 for 99238 and the $109 that Medicare pays for 99239. Explain the importance of listing time spent in the documentation so the oncologist is aware of it in the future.