Pulmonology Coding Alert

Question: What are the requirements for billing an E/M service for discharge day management? Do history, exam and medical decision-making have to be documented? How would the pulmonologist code these services? Rhode Island Subscriber Answer: Hospital discharge services (99238-99239) have very specific requirements. As defined by the CPT manual, these codes include, as appropriate, a final exam, discussion with the patient regarding his or her hospital stay, instructions for continuous care to all caregivers if needed, and preparation of referral forms, prescriptions and discharge records. "As appropriate" means the physician may choose which activities are appropriate for each patient. For example, some physicians may be unable to discuss the stay with an elderly patient who is chronically disoriented and has no available caregivers. Code 99238 is reported when the discharge day activities take 30 minutes or less; 99239 is reported when discharge day activities take more than 30 minutes. The time spent need not be continuous. For example, the doctor visits the patient in the morning and performs the exam but returns that afternoon to review lab results and discharge the patient. The physician would bill only for the one discharge visit (99238). When a physician spends more than 30 minutes in the discharge day activities, for example a patient requires extra attention when reviewing lab results, explaining several medications, diet, activities, etc., the physician can bill 99239. However, the physician must document the amount of time spent. The discharge note in such a case does not need to be expansive but should allow an auditor to clearly see that it was reasonable for the physician to spend more than 30 minutes for discharge management with the patient in that particular case.