New Hampshire Subscriber
Answer: You should use hospital discharge code 99239 (Hospital discharge day management; more than 30 minutes).
CPT contains two discharge codes. For discharge services that take 30 minutes or less, you should report 99238 (... 30 minutes or less). But when the FP spends and documents more than 30 minutes on discharge services, you should instead assign 99239.
Watch out: You shouldn't separately bill the morning encounter. Payers won't reimburse two same-day E/M services. Furthermore, CPT states, "The hospital discharge day management codes are to be used to report the total duration of time spent by a physician for final hospital discharge of a patient."
Better way: You should instead combine the total time the FP spends coordinating the patient's care on the discharge day. Tally the documented minutes to determine whether to report 99238 or 99239.
Remember that 99238 and 99239 describe discharge day management, not just discharge services. The time does not have to be continuous.
And when counting discharge day service time, include these services:
the patient's final examination
the hospital-stay discussion
continuing-care instructions to caregivers
discharge records, prescriptions and referral forms preparation. Tip: Encourage your FP to record start and stop times to show an auditor that he's conscious of time management. Documenting total minutes is less definite.
Tell your FP that taking the extra time to carefully document discharge day management services may pay off.
Code 99239 reimburses at a national rate of $96.64 - over $25 more than 99238 pays on average. The 2005 National Physician Fee Schedule assigns 1.87 relative value units ($70.87 geographically unadjusted rate) to 99238 and 2.55 RVUs ($96.64 national rate) to 99239.