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Pulmonology Coding Alert

READER QUESTION ~ No Inpatient Direct Contact = No E/M Service

Question: The January 2007 Pulmonology Coding Alert "Reader Question: Bill 99238-99239 When Face-to-Face Occurs" states, "When reporting discharge day management service, you must provide and document a face-to-face encounter for that inpatient day." Does that mean that if a pulmonologist does not provide a face-to-face service on the day of discharge, he cannot charge an E/M service?

Wisconsin Subscriber Answer: The pulmonologist cannot report an inpatient service unless a face-to-face encounter occurs on that day. If the physician does not see the patient on the day of discharge, or any other day during the hospitalization, he may not report any E/M service.

You should, however, report face-to-face services based on when the direct contact (face-to-face service) occurs. Here's how:

1. If the physician sees the patient the day prior to discharge, the physician can report the appropriate subsequent hospital care code (99231-99233, Subsequent hospital care, per day, for the E/M of a patient ...).

2. If the physician sees the patient on the day of discharge, he may choose the most appropriate code that represents the amount of floor/unit time he spends with the patient and other activities directed toward the discharge. For discharge services of 30 minutes or less, use 99238 (Hospital discharge day management; 30 minutes or less). Report discharge services taking more than 30 minutes as 99239 (... more than 30 minutes). Answers to You Be the Coder and Reader Questions reviewed by Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.


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