When discharging a patient from the hospital, there are only six possible CPT® evaluation and management (E&M) discharge codes that the attending physician has to choose from. They are the inpatient discharge codes (30 minutes or less CPT® 99238 or the greater than 30 minutes discharge planning CPT® 99239), the same day global admit discharge same day codes (CPT® 99234-99236), and the observation discharge code CPT® 99217. Make sure to reference the AMA's CPT 2013 Standard Edition as the authority on CPT® codes.
I have a whole series of medical billing and coding lectures to help you navigate the crazy world of E&M. In fact, I actually carry my own coding card with me (see below) and reference it for every patient I see in the hospital, every time. The rules are simply obnoxious and no reasonable beaurocrat can expect any health professional to remember all these rules on every patient, every day, every time.
Except if you're dealling with the discharge codes. They're easy to remember, especially the observation discharge code. If a patient is brought in under observation status, if you discharge them on any calendar day different than the day you admitted them, the only possible discharge code you can use is CPT® 99217. There are no crazy rules you have to follow. The visit, like all E&M visits, must be a face-to-face encounter, but there are no time limits you have to meet and no specific crazy rules like most other E/M codes. You just discharge the patient and bill the CPT® 99217 observation discharge code.
It's that easy. Remember one thing, if the patient is a Medicare patient, Medicare requires a patient to be in the hospital for a minimum of eight hours before they will consider an observation stay as medically necessary. Somehow, somewhere eight hours became the magic number for medical necessity. So if you have a patient in under observation status, and they've been there less than eight hours, round on them last or take your wife out for a very long fine afternoon lunch date before returning for your discharge rounds. It's WIN-WIN.
|LINK TO E/M POCKET REFERENCE CARD POST|