December 11th, 2015
By: Scott Kraft (Nov/18/2013)
Medicare will typically pay for a hospital discharge service (billed with 99238-99239) and a nursing facility admission visit (99304-99306) when billed on the same date of service (DOS) by the same provider without the need for a modifier. As always, however, there are a couple of exceptions.
The discharge day management services are billed for the services provided to the patient at discharge. You use 99238 for a service of 30 minutes or less and 99239 for services of 31 minutes or more. The pay difference between the services is approximately $35, depending upon where you’re located.
Discharge services run the gamut from the exam provided to the patient that day, furnishing of discharge instructions, arrangement of follow-up care after the hospitalization, writing prescriptions, etc. The service technically does not need to always be billed on the actual date of discharge, but can be billed only once during the hospitalization.
When the same provider admits the patient to the skilled nursing facility or nursing facility, the physician may bill the appropriate admission code from the 99304-99306 range.
Of the admit codes,99304 requires a detailed or comprehensive history and exam and medical decision making of straightforward or low complexity; 99305 requires a comprehensive history and exam and medical decision making of moderate complexity; 99306 requires a comprehensive history and exam and medical decision making of high complexity.
The exception: A surgeon cannot bill for an admission to a nursing facility when the reason for the admission is directly related to the surgery that has a global period. In that case, the nursing facility admit and any subsequent nursing facility services are including in the global payment for the surgery, according to CMS.
The exception to the exception: When the surgeon refers the patient to a nursing facility for a reason that is not related to the surgery, the surgeon may bill the nursing facility admit along with modifier 24 for unrelated E/M services during a global period.
One last reminder: When the patient is admitted to and discharged from inpatient status on the same date of service, don’t bill 99238-99239. Instead, bill the appropriate code from the 99234-99236 series.
These policies are detailed in Medicare’s Internet Only Manual, Pub. 100-04, Chapter 12, Section 18.104.22.168.