Wiki Discharge Management

[tammymills97]

In need of some help with 99238 and 99239.

I have a provider that is stating codes 99238 and 99239 are based only on the time he spends face-to-face with the patient and cannot include the time spent away from the patient preparing paperwork and writing orders. We showed him the CPT book and the requirements of the code and his statement is that the CPT is only an advisory to Medicare. He is citing as his reference Chapter 12 of the CMS Claims Processing Manual that states it is a face-to-face visit. He states that as this states nothing about the time spent preparing other documents and speaking with other providers/caretakers it cannot be included in the time of discharge and only the time spent face-to-face with the patient can be counted. So far I have been unable to find anything from NGS, our MAC, in regards to this and any help would be greatly appreciated.

Thanks!!

 

[Cynthia Hughes]

There are a couple of things to consider here. MM5794 instructs, "Paperwork involved in patient discharge day management services is paid through the pre- and post-service work of an E/M service." This indicates completion of paperwork is excluded from time reported to Medicare though CPT clearly includes it. However, CMS does recognize unit/floor time in the discussion of hospital services other than prolonged services so time spent on the unit/floor discussing and coordinating the patient's care with other providers would be included. Hopefully others can offer a more specific reference from CMS or one of the contractors.