Hospital discharge, nursing facility admit billable on same day by same provider in most instances

November 18th, 2013 - Scott Kraft
Categories:   Billing   Evaluation & Management (E/M)  
0 Votes - Sign in to vote or comment.

Medicare will typically pay for a hospital discharge service (billed with 99238-99239) and a nursing facility admission visit (99304-99306) when billed on the same date of service (DOS) by the same provider without the need for a modifier. As always, however, there are a couple of exceptions.

The discharge day management services are billed for the services provided to the patient at discharge. You use 99238 for a service of 30 minutes or less and 99239 for services of 31 minutes or more. The pay difference between the services is approximately $35, depending upon where you’re located.

Discharge services run the gamut from the exam provided to the patient that day, furnishing of discharge instructions, arrangement of follow-up care after the hospitalization, writing prescriptions, etc. The service technically does not need to always be billed on the actual date of discharge, but can be billed only once during the hospitalization.

When the same provider admits the patient to the skilled nursing facility or nursing facility, the physician may bill the appropriate admission code from the 99304-99306 range.

Of the admit codes,99304 requires a detailed or comprehensive history and exam and medical decision making of straightforward or low complexity; 99305 requires a comprehensive history and exam and medical decision making of moderate complexity; 99306 requires a comprehensive history and exam and medical decision making of high complexity.

The exception: A surgeon cannot bill for an admission to a nursing facility when the reason for the admission is directly related to the surgery that has a global period. In that case, the nursing facility admit and any subsequent nursing facility services are including in the global payment for the surgery, according to CMS.

The exception to the exception: When the surgeon refers the patient to a nursing facility for a reason that is not related to the surgery, the surgeon may bill the nursing facility admit along with modifier 24 for unrelated E/M services during a global period.

One last reminder: When the patient is admitted to and discharged from inpatient status on the same date of service, don’t bill 99238-99239. Instead, bill the appropriate code from the 99234-99236 series.

These policies are detailed in Medicare’s Internet Only Manual, Pub. 100-04, Chapter 12, Section 30.6.9.2.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Healthcare Common Procedure Coding System (HCPCS)
August 13th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
There are three main code sets and Healthcare Common Procedure Coding System (HCPCS), is the third most common code set used. They are often called Level II codes and are used to report non-physician products supplies and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, ...
Q/A: I Billed 2 Units of L3020 and Claim was Denied. Why?
August 13th, 2019 - Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA
Question: We billed 2 units of L3020 but were denied for not using the right modifiers. What should we do? Answer: Rather than submitting two units of the L3020 to indicate that the patient one orthotic for each foot, you would need to use modifiers identifying left foot and right foot. Appropriate coding ...
Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?
August 13th, 2019 - Wyn Staheli, Director of Research
Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.
The OIG Work Plan: What Is It and Why Should I Care?
August 9th, 2019 - Namas
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
CMS Proposes to Reverse E/M Stance to Align with AMA Revisions
August 6th, 2019 - Wyn Staheli, Director of Research
On July 29, 2019, CMS released their proposed rule for the Medicare Physician Fee Schedule for 2020. Last year’s final rule “finalized the assignment of a single payment rate for levels 2 through 4 office/outpatient E/M visits beginning in CY 2021.” It also changed some of the documentation requirements (e.g., ...
Q/A: What if my Patient Refuses to Fill out the Outcome Assessment Questionnaire?
August 6th, 2019 - ChiroCode
Question: What if my Medicare patient refuses to fill out the outcome assessment questionnaire? Answer: Inform the patient that Medicare requires that you demonstrate functional improvement in order for them to determine if the care is medically necessary. In other words, they may have to pay for the care out of pocket if ...
The Slippery Slope For CDI Specialists
August 2nd, 2019 - Namas
Who knew that when Jack & Jill when up the hill to fetch a pail of water, they would have to ensure that in order to keep the level of water the same on the way back down, they would need to both support the pail. Many of you in this industry are ...



About Codapedia by InnoviHealth Systems Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™ by InnoviHealth Systems™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association