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Click here for more sample CPC practice exam questions and answers with full rationale

Patient appealing discharge

Hi everyone,
Something we are seeing more and more of is providers discharging the patient and completing all of the discharge requirements only to have the patient appeal the discharge. I was wondering if you still bill the discharge if the patient wins the appeal? If not, would you change the visit to a subsequent visit. Hoping someone can answer this as I can’t find anything myself.

Happy Holidays!!!!

Medical Billing and Coding Forum

Changing patient from Inpatient to Observation after discharge

Can you change a patient status from Inpatient to Observation (or vice versa) once the patient has been discharged?
Also, can we change it just because the insurance says if you do we will pay you because the other does not meet medical necessity?

Medical Billing and Coding Forum

Coding inpatient discharge summary diagnosis

I have come across many inpatient discharge diagnosis that do not match. For example the discharge diagnosis will Schizophrenia but below that it will have the axis 1 and it will say Paranoid Schizophrenia. I was always taught to go with the "discharge diagnosis" when billing the discharge summary, however the axis 1 was more specific. Are there any rules regarding which one to use for billing the discharge summary?

thanks

Darla

Medical Billing and Coding Forum

Discharge Services

I am working on some practice reports and the first two were for discharge services. The first was for a total abdominal hysterectomy with bilateral salpingo-oophorectomy. There were no discharge services reported for this report as the rationale stated it was included globally with the surgery charge. The second report was for a endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy and the discharge was reported separately. My question is if it is not stated in the code how do you know for sure when the discharge service should be reported separately or when it is to be billed globally with the surgery.

Medical Billing and Coding Forum

Hospital discharge codes 99238 & 99239

I’m seeking feedback on the time statement requirement for hospital discharge code 99238. I interpret the guideline to state that time must be documented for BOTH 99238 and 99239. However, I have a co-worker that states that guideline only requires the time statement (30 minutes or greater) when billing the 99239. After providing reference to the guideline below, I’m told that if no time is documented, we can automatically assume it was less than 30 minutes and bill a 99238.

Whereas, another co-worker asked if time is not documented for a 99238/99239, can a daily round (99231-99233 or 99224-9226) be billed if documentation supports the required components for this category?

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Medical Billing and Coding Forum

Hospital Discharge workup prior to the actual discharge date

Hello,

I need some clarification on the scenario below. Please help!

On 08/02/2018, Ms. G was admitted to the hospital. On 8/04/2018, Dr. X examined the patient and found she was stable and ready to be discharged. Dr. X discussed the discharge to a nursing home with Ms. G and she agreed. Dr. X created the Discharge Summary and coded the encounter as a Discharge. There was a transportation issue with the nursing home and Ms. G ended up staying inpatient for another night.

On 8/05/2018, Dr. K was doing rounds at the hospital and examined Ms. G. She was still stable and agreed to be discharged. Dr. K created a Progress Note and coded a subsequent inpatient code.

Both physicians are Internal Med. specialists.

My questions are:
Can the discharge summary be created prior to the actual discharge date, causing the date of service to be different then the actual discharge date?
Can a subsequent inpatient code (99231-99233) be billed after the discharge code (99238) was billed? If not, what should be billed?

Thank you for your help!

Medical Billing and Coding Forum

99234-99236 Admit / Discharge Same Date

To calculate time of more than 8 hrs but less than 24 hrs guideline for admit/discharge same date (99234-99236), which of the following should be used?
a. ER/hospital arrival time and discharge
b. inpatient/observation order time and discharge
c. physician’s initial visit and discharge

Medical Billing and Coding Forum

Discharge Summary

Hello, I am a new coder and have some issues with Discharge summaries for Inpatient and Observation. If we have a doctor who documented a progress note and a discharge for the same day, we bill the Discharge, correct?
I thought this, but when I asked a provider to sign the documentation for the DC, he told me that he already signed the progress note and so the DC is not billable.
Does this mean we only bill the one the provider signed instead?

Thanks,

Medical Billing and Coding Forum

NP Subsequent Hosp Visits? and Discharge?

INPATIENT setting
NP Is part of our private practice (NOT a Hosp NP) (Our MD has privileges at hosp not employed by them)
I know she can see PT as consults at hospital. However, I once was told that I cannot bill for subsequent visits.
I am looking for info input or documentation-
-Our NP sees patient on Subsequent visits in the hospital, can she get paid for this? …if only she sees the PT?
I bill for Illinois and Missouri. Please advise, thanks, Kimber

Medical Billing and Coding Forum