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But let's review some basics for all the hospital-based discharge codes. In addition to 99238 and 99239, you can bill two other discharge codes: 99217 (observation care discharge) and 99234-99236 (observation care services including same-day admit and discharge).
According to CPT, the initial hospital care codes, 9922199223, are for the first hospital inpatient encounter with the patient by the admitting physician. Initial inpatient encounters by other physicians should be reported with either subsequent hospital care codes (9923199233) or initial inpatient consultation
Suggested clip Physician Documentation: Discharge Summary — YouTubeYouTubeStart of suggested clipEnd of suggested clip Physician Documentation: Discharge Summary — YouTube
Physical should clearly document the discharge Dx, course of medicine/treatment and any other exam if he has performed on the day of discharge. Performing a physical examination is not mandatory. The code also does not require any PE points to count for a particular level of PE.
You can bill the discharge management code only once per hospital stay, on the day of the actual discharge. You cannot bill for a subsequent hospital visit on that day, in addition to the discharge code.
Admit Through Discharge — Use for a bill encompassing an entire inpatient confinement or course of outpatient treatment for which it expects payment from payer or which will update deductible for inpatient or Part B claims when Medicare is secondary to an Employer Group Health Plan (EGP) 2.
Billing for patients who leave against medical advice. According to CPT, hospital discharge codes 99238 (hospital discharge day management; 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.
Several sources, including a representative from Medicare, have confirmed that Medicare has no policy to deny payment of hospital charges to patients who leave AMA. Payments are made based on a determination of whether care was medically necessary, regardless of how the patient is discharged.
No. If you physician says you are medically ready to leave, the hospital must discharge you. If you decide to leave without your physician's approval, the hospital still must let you go. The hospital administrator and nurses will urge you to stay because they have a duty to attempt to make you follow medical advice.
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