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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 3:00 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). The hospital record would show the patient was an inpatient at midnight on May 1, 2011. The determination of time is based on the amount of time the patient was considered an inpatient or an observation patient on that date of service. For more information, see CMS Internet-Only Manual (IOM) Publication 100-04, Chapter 12, Section 30.6.8.B.

Question 2: I ordered observation care for 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 observation care on May 2, 2011, at 1:00 pm. What code is appropriate?

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 observation admission/discharge services (99234-99236). The hospital record would show the patient was in observation at midnight on May 1, 2011. The determination of time is based on the amount of time the patient was considered an inpatient or an observation patient on that date of service. 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, 2011. I saw the patient on May 1, 2011, around 5:00 pm to personally pronounce death. What procedure code do I submit?

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). The hospital record would show the patient was an inpatient at midnight on May 1, 2011. The determination of time is based on the amount of time the patient was considered an inpatient or an observation patient on that date of service. 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, 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).