Pediatric Coding Alert

Question: Some newborn discharge claims contain 99238, and others list 99239. Which is correct?


Ohio Subscriber

 
Answer: Either code may be correct. The discharge day management codes are time-based, so the correct code depends on the time the pediatrician spends performing discharge services. For discharge services lasting 30 minutes or less, use 99238 (Hospital discharge day management; 30 minutes or less). When the physician spends more than 30 minutes on discharge services, as may occur with a newborn who has a minor problem that requires additional discharge time, such as giving detailed instructions to the caregiver, report 99239 (... more than 30 minutes).

Remember: Inpatient time constitutes total floor time, not just patient-physician face-to-face time. The time does not have to be continuous and represents "the total duration of time spent by a physician for final hospital discharge of a patient," according to CPT's hospital discharge services notes. Services may include final examination of the patient, instructions for continuing care for all relevant caregivers, and preparation of discharge records, prescriptions and referral forms.

Make sure to choose either 99238 or 99239. They are stand-alone codes that you should never report together.