Pulmonology Coding Alert

Question: A family practice physician admitted a patient for treatment of severe abdominal pain. My pulmonologist was consulted for evaluation and management options of acute bronchitis in this patient with COPD and he followed the patient through the episode of care. Both physicians want to report the hospital discharge. Can they split the discharge billing? If not, who should report it?

Maryland Subscriber

Answer: Because the family practice physician is the admitting or attending physician, he reports the discharge code (99238-99239, Hospital discharge day management &). According to CPT Hospital Discharge Services instructions , To report concurrent care services provided by a physician(s) other than the attending physician, use subsequent hospital care codes 99231-99233.

Remember: Medicare and many other payers allow only the admitting physician to bill a discharge for the patient, unless a formal transfer of care occurs and the admitting physician/group is no longer on the case.

However, if another physician in the same practice performs the discharge service -- for example, if the admitting doctor is not available at the time of discharge  -- you can still bill 99238-99239. When physicians are all

members of the same group and specialty, any of them can perform the discharge.

In your case, the family physician admits the patient and consults the pulmonologist. The pulmonologist actively manages the day-to-day pulmonary care for the patient, and the family physician writes notes that concur with his management and outlines the care he provides the patient. In the meantime, the family physician gets paid for daily management of the non-pulmonary issues, while the pulmonologist gets a consultation fee and follow-up visit fees for the patients pulmonary care. Upon discharge, the family physician gets to report 99238-99239, even if the pulmonologist writes all the follow-up discharge orders.

The pulmonologist is able to bill 99231-99233 on the day of discharge for his face-to-face services on that day.