2025 CPT code 99238
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Hospital Inpatient and Observation Care Services Evaluation and Management Feed
Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter.
Modifiers may apply depending on the specific circumstances of the encounter.For example, modifier 25 might be used if a significant, separately identifiable E/M service is performed on the same day of the discharge visit.Always consult the official CPT guidelines for appropriate modifier usage.
Medical necessity is established by the need for a comprehensive discharge visit on the day of hospital discharge. This ensures proper instruction and coordination for continuing care to prevent readmissions and ensure patient safety.Specific documentation supporting the medical necessity for the discharge services must be provided.
The physician or qualified healthcare professional is responsible for the comprehensive evaluation and management of the patient on their discharge day, including the final examination, discussion of the hospital course, and providing appropriate discharge instructions and prescriptions. Coordination of post-discharge care is also included.
- Evaluation and Management
- Evaluation and Management > Hospital Inpatient and Observation Care Services
In simple words: This code covers a doctor's visit on the day a patient leaves the hospital.The doctor checks on the patient, discusses their stay, gives instructions for home care, and prepares paperwork like prescriptions and referrals. This visit lasts 30 minutes or less.
This CPT code reports hospital inpatient or observation discharge day management services provided by a physician or other qualified healthcare professional.The service includes final patient examination, discussion of the hospital stay, instructions for continuing care to all relevant caregivers, and preparation of discharge records, prescriptions, and referral forms.The total time spent on the date of the encounter is 30 minutes or less, and this time does not need to be continuous. This code is used to report all services provided to a patient on the date of discharge, excluding the initial date of inpatient or observation status. For patients admitted and discharged on the same day, codes 99234, 99235, or 99236 may be more appropriate.
Example 1: A patient is discharged from a three-day inpatient stay for pneumonia. The physician spends 25 minutes reviewing the hospital course, providing discharge instructions for medication management, and arranging follow-up care with the patient’s primary care physician., A patient is discharged from observation status following a suspected myocardial infarction that proved negative. The physician spends 15 minutes discussing test results, discharge instructions, and answering the patient's questions about diet and activity restrictions., A patient is discharged from a five-day hospital stay for a total hip replacement. The surgeon spends 30 minutes reviewing the surgical procedure, providing specific postoperative instructions, and arranging for physical therapy and home health services. (Note:This scenario is at the upper limit of this code's time; code 99239 would be more appropriate if time exceeds 30 minutes)
Detailed medical record documentation is crucial for proper coding and reimbursement.Documentation should include:* Comprehensive history of the current illness, including relevant findings from the hospital stay.* Physical examination findings on the day of discharge.* Assessment and plan, detailing the diagnosis, prognosis, and discharge instructions.* Documentation of any medication changes, new prescriptions, or referral information.* Time spent with the patient on the day of discharge, including all aspects of the discharge management.
** The time spent should be documented accurately, including all components of the discharge management process. If the total time spent exceeds 30 minutes, code 99239 should be used instead.Always refer to the most recent CPT coding guidelines and payer policies for the most current and accurate information.
- Revenue Code: M2B (HOSPITAL VISIT - SUBSEQUENT)
- RVU: Refer to the CMS Physician Fee Schedule for the most current Relative Value Units (RVUs) and payment rates. RVUs vary based on geographic location and other factors.
- Global Days: The global period for this code is not explicitly defined; consult the appropriate payer's guidelines for specific information on bundled services or global periods.
- Payment Status: Active
- Modifier TC rule: The Technical Component (TC) modifier does not typically apply to this code as it primarily represents the physician's work. However, consult the current CPT guidelines and payer's rules for any exceptions or limitations.
- Fee Schedule: Historical fee schedules are subject to change; consult the CMS Physician Fee Schedule for current payment information.Past payment amounts would require accessing historical fee schedules from CMS.
- Specialties:All specialties involved in inpatient care may utilize this code, including but not limited to internal medicine, surgery, cardiology, and family medicine.
- Place of Service:Inpatient Hospital, Observation Status