How To Use CPT Code 99239

CPT 99239 refers to hospital inpatient or observation discharge day management services that take more than 30 minutes on the date of the encounter. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99239.

1. What is CPT 99239?

CPT 99239 is a medical billing code used to describe hospital inpatient or observation discharge day management services provided by a healthcare provider. These services involve evaluation and management (E/M) and take more than 30 minutes on the date of the encounter. The code is used to bill for services such as providing continuing care instructions, preparing discharge forms, and writing prescriptions for patients in the inpatient hospital or observation setting.

2. 99239 CPT code description

The official description of CPT code 99239 is: “Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter.”

3. Procedure

The 99239 CPT code procedure involves the following steps:

1. Evaluation and management (E/M) of the patient’s condition and needs.
2. Providing continuing care instructions to the patient and/or their caregivers.
3. Preparing discharge forms, including any necessary referrals or follow-up appointments.
4. Writing prescriptions for medications, if needed.
5. Ensuring that the total time spent on the date of the encounter is more than 30 minutes. The time does not need to be continuous.

4. Qualifying circumstances

Patients eligible to receive CPT code 99239 services are those who are in the inpatient hospital or observation setting and require discharge day management services. These services must take more than 30 minutes on the date of the encounter. The healthcare provider must perform an evaluation and management (E/M) service, provide continuing care instructions, prepare discharge forms, and write prescriptions as needed.

5. When to use CPT code 99239

It is appropriate to bill the 99239 CPT code when a healthcare provider performs hospital inpatient or observation discharge day management services that take more than 30 minutes on the date of the encounter. The provider must perform an evaluation and management (E/M) service, provide continuing care instructions, prepare discharge forms, and write prescriptions as needed for the patient.

6. Documentation requirements

To support a claim for CPT 99239, the following information needs to be documented:

1. The patient’s medical history and current condition.
2. A detailed description of the evaluation and management (E/M) services provided.
3. Continuing care instructions given to the patient and/or their caregivers.
4. Discharge forms prepared, including any necessary referrals or follow-up appointments.
5. Prescriptions written for medications, if needed.
6. The total time spent on the date of the encounter, which must be more than 30 minutes.

7. Billing guidelines

When billing for CPT code 99239, it is essential to follow the appropriate guidelines and rules. Ensure that the patient meets the qualifying circumstances for the code, and that the required documentation is complete and accurate. Additionally, be aware of any specific payer requirements or policies that may apply to the billing of CPT 99239.

8. Historical information

CPT 99239 was added to the Current Procedural Terminology system on January 1, 1996. The code was changed on January 1, 2023, with the previous descriptor being “Hospital discharge day management; more than 30 minutes.”

9. Similar codes to CPT 99239

Five similar codes to CPT 99239 and how they differentiate are:

1. CPT 99234: Involves hospital inpatient or observation care, including admission and discharge on the same date.
2. CPT 99235: Similar to CPT 99234 but with a different level of complexity and time spent on the encounter.
3. CPT 99236: Similar to CPT 99234 and 99235 but with the highest level of complexity and time spent on the encounter.
4. CPT 99238: Involves hospital inpatient or observation discharge day management services but with a duration of 30 minutes or less on the date of the encounter.
5. CPT 99463: Used for discharge services provided to newborns admitted and discharged on the same date.

10. Examples

Here are 10 detailed examples of CPT code 99239 procedures:

1. A patient with congestive heart failure is discharged from the hospital after a 5-day stay. The provider spends 45 minutes on the date of the encounter, discussing continuing care instructions, preparing discharge forms, and writing prescriptions.
2. A patient with pneumonia is discharged from the hospital after a 7-day stay. The provider spends 35 minutes on the date of the encounter, evaluating the patient’s condition, providing continuing care instructions, and preparing discharge forms.
3. A patient with diabetes is discharged from the hospital after a 3-day stay. The provider spends 40 minutes on the date of the encounter, discussing continuing care instructions, preparing discharge forms, and writing prescriptions for insulin and other medications.
4. A patient with a stroke is discharged from the hospital after a 10-day stay. The provider spends 50 minutes on the date of the encounter, evaluating the patient’s condition, providing continuing care instructions, and preparing discharge forms, including referrals for rehabilitation services.
5. A patient with a hip fracture is discharged from the hospital after a 6-day stay. The provider spends 55 minutes on the date of the encounter, discussing continuing care instructions, preparing discharge forms, and writing prescriptions for pain medications and blood thinners.
6. A patient with a kidney infection is discharged from the hospital after a 4-day stay. The provider spends 32 minutes on the date of the encounter, evaluating the patient’s condition, providing continuing care instructions, and preparing discharge forms, including a referral for a follow-up appointment with a nephrologist.
7. A patient with a gastrointestinal bleed is discharged from the hospital after an 8-day stay. The provider spends 38 minutes on the date of the encounter, discussing continuing care instructions, preparing discharge forms, and writing prescriptions for medications to manage the patient’s condition.
8. A patient with a pulmonary embolism is discharged from the hospital after a 9-day stay. The provider spends 47 minutes on the date of the encounter, evaluating the patient’s condition, providing continuing care instructions, and preparing discharge forms, including a referral for a follow-up appointment with a pulmonologist.
9. A patient with a severe asthma exacerbation is discharged from the hospital after a 2-day stay. The provider spends 31 minutes on the date of the encounter, discussing continuing care instructions, preparing discharge forms, and writing prescriptions for inhalers and other medications to manage the patient’s asthma.
10. A patient with a deep vein thrombosis is discharged from the hospital after a 5-day stay. The provider spends 36 minutes on the date of the encounter, evaluating the patient’s condition, providing continuing care instructions, and preparing discharge forms, including a referral for a follow-up appointment with a vascular specialist.