Tuesday, September 7, 2010

Billing CPT CODE 99238, 99239

Hospital Discharge Day Management Codes 99238 and 99239



Hospital discharge day management codes 99238 (30 minutes or less) and 99239 (more than 30 minutes) are to be used to report the total duration of time spent by a physician for final hospital discharge of a patient.   These codes include (as appropriate):   final examination of the patient; discussion of the hospital stay (even if the time spent by the physician on that date is not continuous); instructions for continuing care to all relevant caregivers; and preparation of discharge records, prescriptions and referral forms.

When reporting procedure codes 99238 or 99239, the medical record documentation should specify the amount of time involved in completing the patient’s hospital discharge day management.   If a physician bills the higher level of discharge day management, procedure code 99239, the total time spent rendering this service must be documented in the patient’s medical record indicating more than 30 minutes.  If procedure code 99239 is billed and no time is documented in the patient’s medical record, Highmark Medicare Services may reduce the service to the lower level of care, procedure code 99238.

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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download