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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, based on my orders. I am the principle physician of record for the patient. I saw the patient on May 2. I saw the patient at 8:00 am and then discharged the patient at 3:00 pm. What is the appropriate procedure code?

Answer: The National Claims History file will show the patient was admitted on May 1. Therefore, the service provided on May 2 will be billed as the initial hospital procedure code. For more information, see CMS Internet-Only Manual (IOM) Publication 100-04, Chapter 12, Section 30.6.8.B.

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

Answer: The National Claims History file will show that patient was admitted on May 1. Therefore, the service provided on May 2 will be the initial inpatient service or the discharge management service, but not both. For more information, see CMS Internet-Only Manual (IOM) Publication 100-04, Chapter 12, Section 30.6.8.B.

Question 3: I admitted the patient by telephone early on May 1. I saw the patient on May 1 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 event if you complete the paperwork on a subsequent date. For more information, see CMS Internet-Only Manual (IOM) Publication 100-04, Chapter 12, Section 30.6.8.B.

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 at 8:00 pm. I personally pronounced the patient deceased at 2:00 am on May 2. How do I bill for these services?

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

Question 6: I ordered observation services for the patient at 9:00 pm on May 1. The initial observation service was performed by the resident. I saw the patient at 8:00 am on May 2 and discharged the patient at 9:00 am. Can I bill the admission/discharge procedure?

Answer: No. The patient was in the observation care since May 1. The service on May 2 would be either the initial observation or the discharge from observation procedure code based on the documentation of your services.