Pediatric Coding Alert

Question: One of our patients had a complex health history and we were among four different practices seeing her. When we billed the hospital discharge code, it got denied—we’re assuming because another one of the doctors billed it before us. Should that doctor split the payment with the other physicians?

Answer: Several physicians might be managing the care of a patient, and all might try to bill for the discharge—but only the attending physician should collect for it.

Most payers only allow the attending physician of record (or physician acting on behalf of the attending physician) to report the hospital discharge day management service (CPT^® code 99238 or 99239). Any other physicians should instead report a subsequent hospital care code (99231-99233) for a final visit with the patient. 

Keep in mind that sometimes a patient may not be eligible for a discharge code. This can happen in various circumstances—for instance, if the patient never left the emergency room and thus was never admitted as an inpatient, in which case the physician would report an ED service code (99281-99285).