Talking about death is never pleasant, however in the health care industry it is a cold reality we cannot avoid. Robert Half once said, "Death is the penalty we all pay for the privilege of life." Dating back to the mid 1990's when I was a Senior Consultant for then Medical Management Institute I always used to get a chuckle form the audience when I was asked how to code for a physician pronouncing a patient's death. My answer with a grin would be "Code it as a discharge, a final discharge." After reading my last sentence it really is much funnier in front of a live audience, not that death is funny.
Anyways, on April 1st CMS Transmittal 1460 became effective. This transmittal ultimately cleared up a lot of confusion on using hospital discharge day management codes (99238-99239). The purpose of my article is to focus on coding for pronouncement of a death although the transmittal addresses other aspects of the hospital discharge day management codes. When a physician is face-to-face when pronouncing a patient's death in the inpatient setting, physicians should use the discharge codes 99238 and 99239. Please keep in mind these codes are time based and require appropriate documentation to demonstrate the time engaged in the actual discharge; 99238 is for a discharge of less than 30 minutes while the 99239 is for a discharge of greater than 30 minutes.
One mistake I see a lot of providers making with regard to documentation of time is when they say discharge took greater than 30 minutes. This statement is not appropriate and if audited by CMS will be down coded to the 99238. When documenting time for the 99239 a proper statement would be "Discharge time of 40 minutes." Please do not forget that time is not the only documentation required for a discharge. Discharge codes according to the CPTã are to be used to report the total duration of time spent by a physician for final hospital discharge of a patient. The 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.
For many years there was a lot of confusion as to whether or not a provider could bill for the pronouncement of a patient's death when they were face-to-face. Medicare transmittal 1460 clears this up and confirms that this can be billed for using the discharge day management codes 99238 and 99239. There are two additional points the transmittal identifies that I believe are important as well and they are:
Only the physician who personally performs the pronouncement of death may bill for the face to face hospital discharge day management services The date of service for the death pronouncement must be the date it was performed, even if the paperwork is delayed to a subsequent date.
For more information regarding the use of hospital discharge day management codes refer to the Medicare Claims Processing Manual, Pub. 100-04, Chapter 12, Section 188.8.131.52.
Sean M. Weiss is Vice President of DecisionHealth Professional Services (DPS) and is a nationally recognized speaker and leading health care consultant in practice management operations, coding and billing audits, compliance, and regulatory guidance for physician based practices, hospitals, and other health care organizations of all size. Since 1997, Sean has worked with hundreds of physicians, medical groups, hospitals, and other provider organizations. He has been a featured speaker with numerous medical societies, coding organizations and pharmaceutical companies. For more information on Sean or any of the healthcare professionals of DPS please visit them online at http://www.decisionhealth.com/Consulting/consulting.aspx or contact Sean directly at SWeiss@decisionhealth.com. You can also reach them at 888.262.8354 to find out how DPS professionals may be able to assist your organization.
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