Pulmonology Coding Alert

Question: The pulmonologist discharges a patient from the hospital and then admits him to a nursing facility. The pulmonologist did not go to the NF for this admit or perform a follow-up. Should I charge an NF visit?

Washington Subscriber

Answer: No. You should code only the hospital discharge (99238, Hospital discharge day management; 30 minutes or less; or 99239, ... more than 30 minutes).

The nursing facility admission (99304-99306, Initial nursing facility care, per day, for the evaluation and management of a patient ...) requires a face-to-face physician-patient encounter at the facility. The physician who admits the patient to an NF is the one who certifies the stay, and takes responsibility for the patient's total care throughout the NF stay. This is typically not the pulmonologist, but a primary-care or geriatric physician.

Tip: Checking the place of service will help you avoid denials. Place of service codes must match billed service codes. You have to use 99304-99306 with POS 31 (Skilled nursing facility) or 32 (Nursing facility), and 99238-99239 with 21 (Inpatient hospital).