Urology Coding Alert

When a patient is admitted and discharged on the same day, consider the place of admission or observation, time spent in the facility, and calendar day(s) involved. Following are examples that may be encountered in everyday urological practice, according to Michael A. Ferragamo, MD, clinical assistant professor of urology, State University of New York, Stony Brook.
Same-Day Inpatient Admission and Discharge  
A patient is admitted to a hospital at 6 a.m. because of severe renal colic (788.0). He passes a calculus at 5 p.m. and is completely asymptomatic and afebrile. The urologist discharges him after evening rounds at 8 p.m. The patients stay in the hospital is 14 hours. Use same-day hospital admission and discharge codes (99234-99236) for a stay of eight hours or more, but less than 24 hours.
 
At 8 a.m. a 70-year-old patient is admitted to the urological service because of severe testicular pain. At 8:30 a.m. a testicular ultrasound reveals epididymitis (604.90, Other orchitis, epididymitis, and epididymo-orchitis, without mention of abscess; unspecified), and antibiotics are started. The patient rapidly improves and desires immediate discharge. He is discharged at noon on antibiotics. Because his hospital stay is less than eight hours, report the hospital admission (99221-99223) only. Do not also bill a discharge code.
 
Note: The eight-hour rule for 99234-99236 applies to Medicare only, not to commercial payers, explains Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C. For commercial payers, use 99234-99236 for same-day admission and discharge including stays of less than eight hours.
 
If the urologist performs a procedure during a same-day admission and discharge, only an admission code can be billed, with no discharge code. For example, at 1 a.m. a patient is admitted to the hospital because of severe gross hematuria (599.7). Emergency cystoscopy (52214) at 7:30 a.m. reveals a small bleeding vessel in the bladder, which is easily fulgurated with spontaneous clearing of urine. The patient is discharged following his supper at 8:30 p.m. Code a hospital admission (99221-99223) with modifier-25 to indicate a significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service and 52214. Do not charge a discharge code, because 52214 has a zero-day global. If the patient goes home the next day, report a hospital discharge (99238-99239) for that day.
Observation Status  
Hospital observation status is an outpatient place of service and is usually for a stay of less than 24 hours. The emergency department (ED) often serves as the place of service for observation status. After 24 hours of observation, use the established patient office visit outpatient codes (99211-99215).
 
Use observation codes that include admission and discharge (99234-99236) for patients admitted for observation services and discharged the [...]