CPT® 99238 and 99239 Hospital Discharge E&M Codes and Billing Explained.

Can you bill a discharge code CPT® 999238 or 99239 on a day different from the discharge day, such as the day before the patient actually leaves the hospital?  I received this question from a reader.

Dear happy, how do you code when for a patient that was "discharged" by your partner but then has to stay an extra day for placement or whatever. Do I bill for discharge, or does my partner have to resubmit his coding card and remove his discharge day code? This would not be easy because the cards are usually tuned in and the original hospitalist will probably never be aware that the patient was not discharged on the intended day.

If the hospitalist the day before discharged the patient but the patient didn't go until the following day because of placement issues, you can let the discharge code stand as billed by your partner, as long as you don't bill anything on the following day, the day the patient actually left the hospital.

You can bill a discharge code on a day different than when the patient actually leaves.  CMS had a major rule change last year that allows you to bill a discharge code, even if the patient doesn't leave on that calendar day.  I discussed it here on my blog last year.

I invoke the rule on a regular basis when I do all the discharge work that includes dictating and contact ing the patient's out patient primary care physician on a Sunday with plans to leave to the nursing home on a Monday.

Because I did all the work for discharge, I bill the discharge code, either 99238 or 99239,  on the Sunday and leave a  note for my partner that the patient is leaving on Monday, but that nobody has to see them. The only difference between a 99238 and a 99239 is that a 99239 is greater than 30 minutes spent on discharge and a 99238 is thirty minutes or less spent on discharge. Please reference the AMA's CPT 2014 Standard Edition as the definitive authority in CPT® coding, available below and to the right from Amazon.

If you bill a 99239, you only need to indicate that you spent greater than 30 minutes on the discharge process in your face-to-face evaluation.   There are no other specific criteria needed such as HPI or physical exam.  These are time based CPT® codes.  If you don't document greater than 30 minutes spent on the discharge process, then the CPT® code defaults to a 99238. 

Obviously, you can't bill a discharge code on the Sunday and a followup code on the Monday.  But you can bill a discharge code on Sunday and bill nothing on Monday when the patient actually leaves the hospital.  You simply don't bill a Monday code and the patient leaves to the nursing home on the Monday.  That way, the new hospitalist coming on service doesn't have to sit there and read the whole chart to try and learn the patient who is leaving in an hour.

However, if the patient doesn't leave on the Monday, the new hospitalist should bill a follow up code and the Sunday hospitalist's billing code should get changed  changed to an inpatient code.  But remember, if you provide discharge work, document the time spent as you can reference this amount of time and add it to any other additional discharge work time provided  if you plan on submitting a 99239   if that total cumulative time exceeds 30 minutes.

How often are these inpatient discharge codes 99238 and 99239 used? Here is data from the most recent 2011 CMS Part B National Procedure Summary Files data (2011 zip file) showing how many CPT® 99238 and 99239 encounters were billed and the dollar value of their services for Part B Medicare.    

  • 99238
    • Allowed services - 4,813,009
    • Allowed charges - $332,901,409.85
    • Payments - $263,485,946.27
  • 99239
    • Allowed services - 3,715,492
    • Allowed charges - $378,091,127.55
    • Payments - $299,962,000.40

You can see much more in my free lectures on hospitalist E/M coding as well as a wealth of information in my hospitalist resource center to help you understand what you're worth as a hospitalist.


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