Pulmonology Coding Alert

Question: A pulmonologist coded a patient's hospital charges as one admission, two subsequent days and a discharge. The physician did not see the patient on the discharge date and did the discharge paperwork the night before (the second subsequent day). Should I instead bill the second subsequent day as the discharge?


Wisconsin Subscriber

Answer: No. Discharge day management should only be reported on the day of discharge. Services that occur on any day prior to the actual discharge date are considered subsequent inpatient care. When reporting discharge day management service, you must provide and document a face-to-face encounter for that inpatient day.

The rationale differs for a patient not seen by the physician in the hospital on the date of admission. When a patient is admitted from the office on day 1 and the pulmonologist speaks with the hospital, gives orders, etc. but does not see the patient until day 2. You can't bill for the admission on day 1. You instead code for the outpatient face-to-face encounter (such as 99201-99215, Office or other outpatient visit for the evaluation and management of a ... patient ...), and then bill the admission (99221-99233, Initial hospital care, per day, for the evaluation and management of a patient ...) on the date the face-to-face occurs -- the patient's second hospital day.

Note: This scenario typically occurs when the patient is admitted during the late evening hours and the physician is unavailable to see him. Facility policy and other regulations require the physician to see the patient within the first 24 hours of admission.