Wiki Code For Hospital Discharge/Admit On Same Day??

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ABridgman

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OK, I know you can use 99236 for an Admit/Discharge on same day.

But how do I code it for a Discharge/Admit on the same day?

I have tried to code just the 99239 with 25 modifier and then the 99223 - and it doesn't fly.

In this case, a patient got discharged from the Psych Ward of the hospital, and then admitted into the regular area of the hospital as a result of a broken hip.

So on the same day we have a Discharge and then an Admit.

My doctor claims that another doctor he knows gets paid for this. But I have never seen any coding that will work for getting my doctor paid for both the discharge and admit on same day.

Help?
 
Sorry for the delay. I had a family situation out of town.

OK, so what happened is my doc discharged from psych ward as a result of needing to be in the medical section. And my doctor was covering for the normal doc in the medical section.

So my doctor literally did BOTH the discharge and the Admit on the same day.

Like I said, I know how to code Admit/Discharge same day, we get that sometimes with people leaving hospial AMA for example. But this is not a situation I have encountered before.

My doctor claims he should be able to get paid for both.

I know if I try a regular 99239 and the a 99223 on same day, even with 25 modifier, it will get rejected. There must be some way to code this but I do not know what it is.
 
What you are describing is not a discharge and admit situation. The patient's care was transferred from the psych unit to the medical unit. Patient's care was merely transferred from one unit of the hospital to another, the patient never left the hospital so there is no discharge. You can verify this by reading the description of discharge in the CPT book. You say your doc was covering, what did he actually do? Sounds like he assumed care of the patient from psychiatry, made decision on treatment plan, was ortho called in, was patient sent to surgery, he probably wrote all orders for medications and meals, ambulation, physical therapy, etc. That allows for a hospital admission visit only, level to be determined by medical necessity, medical decision making, time spend. Also, it is not appropriate to append modifier 25 to inpatient hospital visits.

If the patient had been physically discharged from the hospital, and something happened to re-admit the patient with all new medical record numbers. You would then be able to bill a discharge and admit but as two separate claims as they would be two separate episodes of care.
 
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This is what I thought.
but the doctor is insisiting that this is a billable discharge and admit.

I will have to explain this to him, I just wanted this on anither coder's opinion than my own.

I will need to clarify with the doctor if the patient actually made it out of the hospital and then came back in on same day. If not...then, as I originally suspected, only the ADMITis billed.
 
Ooooppppps I did use the word admission but should not have.

You are able to bill a visit based on level of care with all things considered as stated but do not use a hospital admit code. Again the patient isn't being admitted to the hospital. There is only a transfer of care. You can only bill a inpatient hospital visit.

If you find out the patient left the hospital totally and came back new admit then you know what to do.

Just curious as to outcome, let me know.

Good luck. Sorry for the confusion.
 
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