Hospital Discharge – A Commonly Misbilled Service

Medical Billing – A Commonly Misbilled Service

Many people believe medical billing can be a pain, but in some instances correct medical billing can bring you additional money. A commonly missbilled service is the professional fee for a hospital discharge. There are many medical billing mistakes made with this service. People bill for the discharge when they are not supposed to, and then don’t bill when they are entitled reimbursement. Medical billing personnel also tend to bill an incorrect CPT code when they do bill for hospital discharge. This hospital discharge medical billing mess needs to get straightened out!

First of all, many times physicians should not bill separately for hospital discharge services. A lot of times this service is included in a global surgical fee. However, some physicians are leaving out the discharge service in medical billing when they actually are entitled to separate reimbursement. These times include: patient has non-global surgery but stays in hospital for complication, patient is readmitted for complications, or a different surgeon does the discharge than the surgeon who performed the surgery. Correct medical billing entitles these physicians for separate reimbursement.

The next problem comes when physicians actually do the medical billing for discharge services. Most of the time they do not record the amount of minutes spent on preparing the discharge summary and the discharge time spent with the patient. This may be leading to about $25 less in reimbursement. The reason being, there are two medical billing codes for discharge 99238 (30 minutes or less) and 99239 (More then 30 minutes). 99239 reimburses at $25 more then 99238, however, without proper documentation, no one would pay the larger amount. Many physicians do medical billing for the 99238 because they think it is less hassle then recording the time spent. However, the only documentation required is the total amount of minutes spent. This medical billing rule is very simple.

Don’t let your physician get lazy. Make sure correct medical billing procedures are followed and your practice may be entitled to an extra $25 on the next claim.

View all Articles by: Melissa Clark, CCS-P