Pulmonology Coding Alert

Question: When can the pulmonologist bill for discharge management services? If the pulmonologist does not bill the actual discharge management services, what services may he or she bill on discharge day?

Delaware Subscriber Answer: Only the primary physician may perform discharge management services. Consequently, if the pulmonologist is the admitting physician, he or she could bill the discharge day management code (99238-99239). If another specialist admitted the patient and the care was transferred to the pulmonologist (for example, if the patient was transferred to the medical intensive care unit), the pulmonologist becomes the primary physician and can bill discharge day management.

If the pulmonologist is called onto the case on a day prior to the patient's discharge, the pulmonologist should bill subsequent care (99231-99233) if he or she sees the patient on discharge day. If the pulmonologist is called in for his or her opinion and advice on discharge day, then the pulmonary physician would bill a consult (99251-99255).

Choosing between reporting 99238 and 99239 depends on how much time the pulmonologist spends providing the discharge day care to the patient. The care includes, as appropriate, final examination of the patient, discussion of the hospital stay even if the time spent by the physician on that day is not continuous, instructions for continuing care to all relevant caregivers, and preparation of discharge records, prescriptions and referral forms. The amount of time spent should be documented in the medical record. If the pulmonary physician spends 30 minutes or less, 99238 is reported. If the doctor spends more than 30 minutes, 99239 is reported.