Wiki HOSPITAL DISCHARGE-NURSING HOME ADMIT SAME DOS

[kat22875]

We are having difficulty with reimbursements for Hospital discharge with same day Nursing Home admit. Most insurances are paying only one charge, either the discharge CPT 99238-99239 or they will pay Nursing home admit CPT 99304-99306. According to coding guidelines, we can report separately. However, we are only getting paid for one of the charges. Does anyone have any insight on this subject?

Katheryn Landry, CPC
Lake Charles, LA

 

[Pam Warren]

According to CPT and CMS, yes. But you'd need to append the -25 on the NH admission to indicate that it's separately identifiable from the inpatient discharge. And be prepared to support the level of admission service with appropriate documentation.

From IOM 10-, Chapter 12, Section 30,6.9.2
D. Hospital Discharge Management (CPT Codes 99238 and 99239) and Nursing Facility Admission Code When Patient Is Discharged From Hospital and Admitted to Nursing Facility on Same Day

A/B MACs (B) pay the hospital discharge code (codes 99238 or 99239) in addition to a nursing facility admission code when they are billed by the same physician with the same date of service.

 

[kat22875]

According to CPT and CMS, yes. But you'd need to append the -25 on the NH admission to indicate that it's separately identifiable from the inpatient discharge. And be prepared to support the level of admission service with appropriate documentation.

From IOM 10-, Chapter 12, Section 30,6.9.2
D. Hospital Discharge Management (CPT Codes 99238 and 99239) and Nursing Facility Admission Code When Patient Is Discharged From Hospital and Admitted to Nursing Facility on Same Day

A/B MACs (B) pay the hospital discharge code (codes 99238 or 99239) in addition to a nursing facility admission code when they are billed by the same physician with the same date of service.

Thank you very much!