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Family Practice Coding Alert

Reader Question:
Discharge to Nursing Home

Question: How do I code a Medicare patient being transferred from the hospital to the nursing home? I need to assign a code for the discharge summary, and the history and physician exam conducted in the nursing home. The doctor also has to complete a nursing home transfer.

Connecticut Subscriber

Answer: Your practice should code 99238 (hospital discharge day management; 30 minutes or less) or 99239 ( more than 30 minutes), depending on the time the physician spent in this activity. Coders may bill 99303 (evaluation and management of a new or established patient involving a nursing facility assessment at the time of initial admission or readmission to the facility), assuming it meets the level of service required for the nursing home admission or readmission services. To report this code, the physician must go to the nursing facility to complete the admission.

Alternatively, code 99379 (physician supervision of a nursing facility patient [patient not present] requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication [including telephone calls] for purposes of assessment or care decisions with other health care professionals and other non-physician professionals involved in patients care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes) is not the best code to use in this scenario because it is a noncovered code within the Medicare program.

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