Question

question 16

dr. inez discharges mr. blancos from the pulmonary service after a bout of pneumococcal pneumonia. she spends 45 minutes at the bedside explaining to mr. blancos and his wife the medications and ippb therapy she ordered. mr. blancos is a resident of the shady valley nursing home due to his advanced alzheimers disease and will return to the nursing home after discharge. on the same day dr. inez re-admits mr. blancos to nursing facility. she obtains a medically appropriate history; a medically appropriate examination and the medical decision making is moderate complexity. what is/are the appropriate evaluation and management code(s) for this visit?

99239
99239, 99305
99238
99238, 99305

Explanation:

Analyze the hospital discharge service

The physician spends 45 minutes at the bedside discharging the patient. Hospital discharge day management codes are selected based on time:

• CPT code 99238: 30 minutes or less.
• CPT code 99239: More than 30 minutes.

Since the physician spent 45 minutes, 99239 is the correct code for the hospital discharge.

Analyze the nursing facility admission service

On the same day, the physician re-admits the patient to a nursing facility. This is a separate service in a different setting.

• The physician performs a medically appropriate history and exam with moderate complexity medical decision making (MDM).
• For initial nursing facility care, CPT code 99305 requires a medically appropriate history and exam, and moderate MDM. Thus, 99305 is the correct code for the nursing facility admission.

Combine the codes for same-day services

Because the services occurred in two different settings (hospital discharge and nursing facility admission) by the same physician on the same day, both the hospital discharge day management service (99239) and the initial nursing facility care service (99305) are reported.

Answer:

• 99239
• 99239, 99305 (Correct answer)
• 99238
• 99238, 99305