Hospital Discharge Day Management Codes 99238 and 99239

99238 Hospital discharge day management; 30 min.


99239 more than 30 min

A Hospital Discharge Day Management Service (CPT code 99238 or 99239) is a face-to-face evaluation and management (E/M) service between the attending physician and the patient.

Only the attending physician of record (or physician acting on behalf of the attending physician) shall report the Hospital Discharge Day Management Service (CPT code 99238 or 99239).

Only the physician who personally performs the pronouncement of death shall bill for the face-to-face Hospital Discharge Day Management Service (CPT codes 99238 or 99239).

Subsequent Hospital Visit and Hospital Discharge Day Management (Codes 99231 – 99239)



A.Subsequent Hospital Visits During the Global Surgery Period

The Medicare physician fee schedule payment amount for surgical procedures includes all services (e.g., evaluation and management visits) that are part of the global surgery payment; therefore, contractors shall not pay more than that amount when a bill is fragmented for staged procedures.


B.Hospital Discharge Day Management Service

Hospital Discharge Day Management Services, CPT code 99238 or 99239 is a face-to- face evaluation and management (E/M) service between the attending physician and the patient. The E/M discharge day management visit shall be reported for the date of the actual visit by the physician or qualified nonphysician practitioner even if the patient is discharged from the facility on a different calendar date. Only one hospital discharge day management service is payable per patient per hospital stay.

Only the attending physician of record reports the discharge day management service. Physicians or qualified nonphysician practitioners, other than the attending physician, who have been managing concurrent health care problems not primarily managed by the attending physician, and who are not acting on behalf of the attending physician, shall use Subsequent Hospital Care (CPT code range 99231 – 99233) for a final visit.

Medicare pays for the paperwork of patient discharge day management through the pre- and post- service work of an E/M service.

C.Subsequent Hospital Visit and Discharge Management on Same Day

Pay only the hospital discharge management code on the day of discharge (unless it is also the day of admission, in which case, refer to §30.6.9.1 C for the policy on Observation or Inpatient Care Services (Including Admission and Discharge Services CPT Codes 99234 – 99236). Contractors do not pay both a subsequent hospital visit in addition to hospital discharge day management service on the same day by the same physician. Instruct physicians that they may not bill for both a hospital visit and hospital discharge management for the same date of service.


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

Contractors 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.

If a surgeon is admitting the patient to the nursing facility due to a condition that is not as a result of the surgery during the postoperative period of a service with the global surgical period, he/she bills for the nursing facility admission and care with a modifier

“-24” and provides documentation that the service is unrelated to the surgery (e.g., return of an elderly patient to the nursing facility in which he/she has resided for five years following discharge from the hospital for cholecystectomy).

Contractors do not pay for a nursing facility admission by a surgeon in the postoperative period of a procedure with a global surgical period if the patient’s admission to the nursing facility is to receive post operative care related to the surgery (e.g., admission to a nursing facility to receive physical therapy following a hip replacement).  Payment for the nursing facility admission and subsequent nursing facility services are included in the global fee and cannot be paid separately.


E.Hospital Discharge Management and Death Pronouncement

Only the physician who personally performs the pronouncement of death shall bill for the face-to-face Hospital Discharge Day Management Service, CPT code 99238 or 99239.

The date of the pronouncement shall reflect the calendar date of service on the day it was performed even if the paperwork is delayed to a subsequent date


Does time need to be documented in order to submit for a hospital or nursing facility discharge service?

Answer:

Yes, the time should be documented in the medical record to support the level of service billed for CPT codes 99238, 99239, 99315 and 99316.

Example: CPT code 99239 is used for a hospital discharge more than 30 minutes. Therefore, the discharge note would state, ’45 minutes spent performing discharge services.’

Policy: 

The Medicare physician fee schedule payment for surgical procedures includes all the services and visits that are part of the global surgery payment including when such surgical procedures may be fragmented. Subsequent Hospital Care visits (Procedure  codes 99231 – 99233) are not separately payable when included in the global surgery payment. The Hospital Discharge Day Management Service (Procedure  code 99238 or 99239) is a face-to-face evaluation and management (E/M) service with the patient and his/her attending physician. Physicians shall use the Observation or Inpatient Care Services (Including Admission and Discharge Services) using a code from Procedure  code range 99234 – 99236 for a hospital admission and discharge occurring on the same calendar date and when specific Medicare criteria, identified in §30.6.9.1, are met. The American Medical Association Current Procedural Terminology (Procedure ) codes 99238 and 99239 shall be paid only when they are performed face-to-face with the patient. Other physicians who manage the patient’s care (concurrent care) in addition to an attending physician, and who are not acting on behalf of the attending physician shall use the Subsequent Hospital Care codes from Procedure  code range Procedure  99231 – 99233 for a final visit with the patient. Medicare includes payment for general paperwork through the pre-and post-service work of E/M services. The physician who personally performs a patient pronouncement of death shall bill for the face-to-face Hospital Discharge Day Management Service using Procedure  code 99238 or 99239. The date of death pronouncement shall reflect the calendar date of actual death pronouncement even if the paperwork is delayed to a subsequent calendar date.

Contractor shall instruct physicians and qualified NPPs that a Hospital Discharge Day Management Service (Procedure  code 99238 or 99239) is a face-toface E/M service between the attending physician and the patient.Contractor shall instruct physicians and qualified NPPs that only the attending physician of record (or physician acting on behalf of the attending physician)  shall report the Hospital Discharge Day Management Service (Procedure  code 99238 or 99239) .

Contractor shall instruct physicians and qualified NPPs that only the physician who personally performs the pronouncement of death shall bill for the face-to-face Hospital Discharge Day Management Service (Procedure  codes 99238 or 99239).



Hospital Discharge Day Management Service

Hospital Discharge Day Management Services, Procedure  code 99238 or 99239 is a face-toface evaluation and management (E/M) service between the attending physician and the patient. The E/M discharge day management visit shall be reported for the date of the actual visit by the physician or qualified nonphysician practitioner even if the patient is discharged from the facility on a different calendar date. Only one hospital discharge day management service is payable per patient per hospital stay.

Hospital Discharge Management (Procedure  Codes 99238 and 99239) and Nursing Facility Admission Code When Patient Is Discharged From Hospital and Admitted to Nursing Facility on Same Day Contractors 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.

Hospital Discharge Management and Death Pronouncement Only the physician who personally performs the pronouncement of death shall bill for the face-to-face Hospital Discharge Day Management Service, Procedure  code 99238 or 99239. The date of the pronouncement shall reflect the calendar date of service on the day it was performed even if the paperwork is delayed to a subsequent date.

Hospital discharge day management codes 99238 (30 minutes or less) and 99239 (more than 30 minutes) are to be used to report the total duration of time spent by a physician for final hospital discharge of a patient.   These codes include (as appropriate):   final examination of the patient; discussion of the hospital stay (even if the time spent by the physician on that date is not continuous); instructions for continuing care to all relevant caregivers; and preparation of discharge records, prescriptions and referral forms.

When reporting procedure codes 99238 or 99239, the medical record documentation should specify the amount of time involved in completing the patient’s hospital discharge day management.   If a physician bills the higher level of discharge day management, procedure code 99239, the total time spent rendering this service must be documented in the patient’s medical record indicating more than 30 minutes.  If procedure code 99239 is billed and no time is documented in the patient’s medical record, Highmark Medicare Services may reduce the service to the lower level of care, procedure code 99238.

Initial Hospital Care and Discharge on Same Day

When the patient is admitted to inpatient hospital care for less than 8 hours on the same date, then Initial Hospital Care, from CPT code range 99221 – 99223, shall be reported by the physician. The Hospital Discharge Day Management service, CPT codes 99238 or 99239, shall not be reported for this scenario.

When a patient is admitted to inpatient initial hospital care and then discharged on a different calendar date, the physician shall report an Initial Hospital Care from CPT code range 99221 – 99223 and a Hospital Discharge Day Management service, CPT code 99238 or 99239.
When a patient has been admitted to inpatient hospital care for a minimum of 8 hours but less than 24 hours and discharged on the same calendar date, Observation or Inpatient Hospital Care Services (Including Admission and Discharge Services), from CPT code range 99234 – 99236, shall be reported.

The Medicare physician fee schedule payment for surgical procedures includes all the services and visits that are part of the global surgery payment including when such surgical procedures may be fragmented. Subsequent Hospital Care visits (CPT codes 99231 – 99233) are not separately payable when included in the global surgery payment. The Hospital Discharge Day Management Service (CPT code 99238 or 99239) is a face-to-face evaluation and management (E/M) service with the patient and his/her attending physician. Physicians shall use the Observation or Inpatient Care Services (Including Admission and Discharge Services) using a code from CPT code range 99234 – 99236 for a hospital admission and discharge occurring on the same calendar date and when specific Medicare criteria, identified in §30.6.9.1, are met. The American Medical Association Current Procedural Terminology (CPT) codes 99238 and 99239 shall be paid only when they are performed face-to-face with the patient. Other physicians who manage the patient’s care (concurrent care) in addition to an attending physician, and who are not acting on behalf of the attending physician shall use the Subsequent Hospital Care codes from CPT code range CPT 99231 – 99233 for a final visit with the patient. Medicare includes payment for general paperwork through the pre-and post-service work of E/M services. The physician who personally performs a patient pronouncement of death shall bill for the face-to-face Hospital Discharge Day Management Service using CPT code 99238 or 99239. The date of death pronouncement shall reflect the calendar date of actual death pronouncement even if the paperwork is delayed to a subsequent calendar date. 

Medicare billing Guidelines
A. Subsequent Hospital Visits During the Global Surgery Period  The Medicare physician fee schedule payment amount for surgical procedures includes all services (e.g., evaluation and management visits) that are part of the global surgery payment; therefore, contractors shall not pay more than that amount when a bill is fragmented for staged procedures.
 B. Hospital Discharge Day Management Service Hospital Discharge Day Management Services, CPT code 99238 or 99239 is a face-toface evaluation and management (E/M) service between the attending physician and the patient. The E/M discharge day management visit shall be reported for the date of the actual visit by the physician or qualified nonphysician practitioner even if  he patient is discharged from the facility on a different calendar date. Only one hospital discharge day management service is payable per patient per hospital stay.
Only the attending physician of record reports the discharge day management service. Physicians or qualified nonphysician practitioners, other than the attending physician, who have been managing concurrent health care problems not primarily managed by the attending physician, and who are not acting on behalf of the attending physician, shall use Subsequent Hospital Care (CPT code range 99231 – 99233) for a final visit. Medicare pays for the paperwork of patient discharge day management through the preand post- service work of an E/M service.  
C. Subsequent Hospital Visit and Discharge Management on Same Day Pay only the hospital discharge management code on the day of discharge (unless it is also the day of admission, in which case, refer to §30.6.9.1 C for the policy on Observation or Inpatient Care Services (Including Admission and Discharge Services CPT Codes 99234 – 99236). Contractors do not pay both a subsequent hospital visit in addition to hospital discharge day management service on the same day by the same physician. Instruct physicians that they may not bill for both a hospital visit and hospital discharge management for the same date of service.
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 Contractors 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.

E. Hospital Discharge Management and Death Pronouncement
Only the physician who personally performs the pronouncement of death shall bill for the face-to-face Hospital Discharge Day Management Service, CPT code 99238 or 99239. The date of the pronouncement shall reflect the calendar date of service on the day it was performed even if the paperwork is delayed to a subsequent date. 
Separate payment may be made for an initial hospital visit (CPT codes 99221 through 99223), an initial inpatient consultation (CPT codes 99251 through 99255), and a hospital discharge service (CPT codes 99238 and 99239) when billed for the same date as an inpatient dialysis service. These services may be billed with a modifier -25 to indicate that they are significant and identifiable services.

Q: May a physician report both a hospital visit and hospital discharge day management service on the same day?

A: No. The hospital visit descriptors include the phrase “per day” meaning they include all care for a day. Codes 99238-99239 (hospital discharge day management services) are used to report services on the final day of the hospital stay. To report both the hospital visit code and the hospital discharge day management services code would be duplicative.


We will continue with the next time based code, hospital discharge services. There are two Procedure  Codes associated with hospital care discharge services. Procedure  Code 99238 represents less than 30 minutes spent on the discharge and Procedure  Code 99239 which is greater than 30 minutes spent on the discharge.

If the patient is discharged on the second calendar day, you may bill Procedure  Codes 99238 or 99239. If the patient is not discharged on day two and remains in the hospital, you may bill Procedure  Codes 99231 through 99233. Reminder: In order to submit any Procedure  Code, all documentation requirements must be met.

We highly recommend documenting the specific time when using Procedure  Codes 99238 or 99239. For example, if you spent 35 minutes performing the discharge service, documented 35 minutes. Avoid using statements such as, ‘greater than 30 minutes was spent performing discharge services.’

We would allow Procedure  Code 99238 if the time was not documented; however, we would down code Procedure  Code 99239 if the time was not documented. I cannot speak on behalf of any other entity such as the RAC, CERT, etc., so it is imperative to document appropriately.

Procedure  Codes 99238 and 99239 are a face-to-face evaluation and management service between the provider and the patient. The manuals state that only the principal physician of record may submit the hospital care discharge service. This code must be reported for the date the actual visit was performed, even if the patient is discharged from the facility on a different calendar date.

The hospital discharge codes 99238 or 99239 may be billed in addition to a nursing facility admission code when they are billed by the same provider with the same date of service. A surgeon who admits to the nursing facility due to a condition that is not as a result of the surgery during the postoperative period of a service with the global surgical period, may bill for the nursing facility admission care with Procedure  modifier 24.

Inpatient Dialysis On Same Date As Evaluation and Management.–Payment for certain evaluation and management services (CPT codes 99231 through 99233, subsequent  hospital visits, and CPT codes 99261 through 99263, follow-up inpatient consultations) is considered bundled into the payment for inpatient dialysis (CPT codes 90935 through 90947) when both are performed on the same day by the same physician for the same beneficiary. Do not pay a physician for both dialysis and a subsequent hospital visit or a follow-up inpatient consultation on the same date of service. If both are billed, pay the dialysis service and deny the evaluation and management service.

Separate payment may be made for an initial hospital visit (CPT codes 99221 through 99223), an initial inpatient consultation (CPT codes 99251 through 99255), and a hospital discharge service (CPT codes 99238 and 99239) when billed for the same date as an inpatient dialysis service. These services may be billed with a modifier -25 to indicate that they are significant and identifiable services.

Payment is not allowed for more than one inpatient dialysis service per day.



Hospital Discharge 99238 – 99239

** Discharge management includes:
** Final exam of patient
** Discussion of hospital stay
** Discharge instruction (including time to instruct family or other caregivers)
** Preparation of discharge records, prescriptions and referral forms
** Time – 30 minutes or less ~ 99238
** Time – More than 30 minutes ~ 99239
** Include all time even if not continuous on the same date

Initial Hospital Care and Discharge on Same Day When the patient is admitted to inpatient hospital care for less than 8 hours on the same date, then Initial Hospital Care, from CPT code range 99221 – 99223, shall be reported by the physician. The Hospital Discharge Day Management service, CPT codes 99238 or 99239, shall not be reported for this scenario.

When a patient is admitted to inpatient initial hospital care and then discharged on a different calendar date, the physician shall report an Initial Hospital Care from CPT code range 99221 – 99223 and a Hospital Discharge Day Management service, CPT code 99238 or 99239. When a patient has been admitted to inpatient hospital care for a minimum of 8 hours but less than 24 hours and discharged on the same calendar date, Observation or Inpatient Hospital Care Services (Including Admission and Discharge Services), from CPT code range 99234 – 99236, shall be reported.



QUESTIONS AND ANSWERS




Q: If a patient is seen in the office at 3:00 p.m. and admitted to the hospital at 1:00 a.m. the next day, may both the office visit and the initial hospital care be reported?

A: Yes. Because different dates are involved, both codes may be reported. The CPT states services on the same date must be rolled up into the initial hospital care code. The term “same date” does not mean a 24 hour period. Refer to the CPT book for more information.



Q: May a physician report both a hospital visit and hospital discharge day management service on the same day?

A: No. The hospital visit descriptors include the phrase “per day” meaning they include all care for a day. Codes 99238-99239 (hospital discharge day management services) are used to report services on the final day of the hospital stay. To report both the hospital visit code and the hospital discharge day management services code would be duplicative.



Q: If a patient is admitted as an inpatient and discharged on the same day, may the hospital discharge day management code be reported?

A: No. To report services for a patient who is admitted as an inpatient and discharged on the same day, use only the appropriate code for Observation or Inpatient Care Services (Including Admission and Discharge Services) as described by CPT codes 99234-99236.

Q: May a physician or separate physician of the same group and specialty report multiple hospital visits on the same day for the same patient for unrelated problems?

A: No. The inpatient hospital visit descriptors contain the phrase “per day” which means that the code and the payment established for the code represent all services provided on that date. The physician(s) should select a single code that reflects all services provided during the date of the service.

Q: In a hospital inpatient situation involving one physician covering for another, if physician A sees the patient in the morning and physician B, who is covering for A, sees the same patient in the evening, will Oxford pay physician B for the second visit?

A: No. The inpatient hospital visit descriptors include the phrase “per day” which means that the code and the payment established for the code represent all services provided on that date. The physician(s) should select a single code that reflects all services provided during the date of the service.

Q: If a physician sees his patient in the emergency room and decides to admit the person to the hospital, should both services (the emergency department visit and the initial hospital visit) be reported?

A: No. When the patient is admitted to the hospital via another site of service (e.g., hospital emergency department, physician’s office, nursing facility), all services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.



Q: If a patient is seen for more than one E/M or other medical service on a single date of service, and each service is performed by a physician with a different specialty designation, but in the same group practice, would each E/M or other medical service be separately reimbursable?

A:  Yes, in certain circumstances. An E/M or other medical service provided on the same date by different physicians who are in a group practice but who have differen specialty designations may be separately reimbursable. The Same Day/Same Service policy applies when multiple E/M or other medical services are reported by physicians in the same group and specialty on the same date of service. In that case, only one E/M is separately reimbursable, unless the second service is for an unrelated problem and reported with modifier 25. This would not apply when one of the E/M services is a “per day” code.