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Combination Admission and Discharge Procedure Codes 99234 - 99236 (Q&As)

Question 1: The Emergency Room physician admitted the patient to an inpatient status on May 1, 2011 based on my orders. I am the principle physician of record for the patient. I saw the patient on May 2, 2011. I saw the patient at 8:00 am and then discharged the patient at 5:00 pm. What is the appropriate procedure code?

Answer: Medicare Part B adjudicates physician services based on the calendar date of the service. In the above situation, the physician would submit the combination hospital inpatient/discharge services (99234-99236). In the Medicare Part B environment, the time of an "admission" to the hospital is not a physician payment issue. The physician service begins when he/she actually see the patient and performs the work for which Medicare may make payment. The "admission" time and date are necessary for the hospital billing, but not for the physician billing.

Question 2: I admitted the patient by phone on May 1, 2011. I saw the patient on May 2, 2011 at 8:00 am. I discharged the patient from the hospital on May 2, 2011 at 1:00 pm. What code is appropriate?

Answer: The medical record documentation determines the appropriate procedure code. The physician could bill an initial inpatient visit or a discharge management summary based on the service documented. The combination admit and discharge procedures codes are not appropriate since the patient was an inpatient for less than 8 hours on May 2, 2011.

Question 3: I admitted the patient by telephone early on May 1, 2011. I saw the patient on May 1, 2011 around 5:00 pm to personally pronounce death. What procedure code do I submit?

Answer: Since your service for this patient was the pronouncement of death, you would submit the discharge management procedure codes 99238 or 99239 depending on the time spent performing this service as documented in the medical records. The date of the pronouncement is the calendar date on which you pronounced them dead even if you complete the paperwork on a subsequent date.

Question 4: I admitted the patient at 8:00 am and ordered several tests. My encounter with the patient met the medical record documentation for an initial inpatient visit. In addition, I provided discharge management instructions should we receive negative test results. I received the final reports at 5:00 pm and all were negative. The patient then left the hospital with the instructions. How do I bill for this service?

Answer: In this rare situation, you provided both an initial inpatient and discharge management service. Because the patient was in the inpatient setting for more than 8 hours, but less than 24, you would bill the combination procedure codes 99234-99236.

Question 5: I admitted the patient to an inpatient status on May 1, 2011 at 8:00 pm. I personally pronounced the patient deceased at 2:00 am on May 2, 2011. How do I bill for these services?

Answer: You would have an initial inpatient service on May 1, 2011 and a discharge management service on May 2, 2011 (provided you meet all requirements of the procedure codes.)