Urology Coding Alert

Question: Can I use CPT 99238, the discharge day management code, with a hospital surgery such as 52204, or is it included in the surgery?

Connecticut Subscriber

Answer: Using a discharge code (99238 or 99239, Hospital discharge day management ...) depends on two criteria.
 
Criteria 1: The thing you'll need to take into account is the number of global days of the surgical procedure. A particular procedure must have a zero-day global in order for you to use a discharge day management code.
 
Criteria 2: The second thing you'll look at is whether  the discharge occurs after the day of the procedure, not on the day of the procedure.
 
If these two criteria are met, you may report a discharge code.
 
Example: In your example, 52204 (Cystourethroscopy, with biopsy) has a zero-day global period and if the discharge occurs after the day of the procedure, you can use the discharge code.
 
In this case, remember to also report all hospital days if the patient does spend time as a hospitalized patient after the surgery. If the procedure carries a 90-day global period, for example, 54840 (Excision of spermatocele, with or without epididymectomy), you should not report a discharge code.