How To Use CPT Code 99238

CPT 99238 refers to hospital inpatient or observation discharge day management services, specifically for 30 minutes or less 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 99238.

1. What is CPT 99238?

CPT 99238 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) of the patient, including providing continuing care instructions, preparing discharge forms, and writing prescriptions. The code is specifically used when the total time spent on the date of the encounter is 30 minutes or less.

2. 99238 CPT code description

The official description of CPT code 99238 is: “Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter.”

3. Procedure

The 99238 CPT code procedure involves the following steps:

1. Evaluation and management (E/M) of the patient’s condition.
2. Reviewing and updating the patient’s medical records.
3. Providing continuing care instructions to the patient and/or their caregivers.
4. Preparing discharge forms, including any necessary referrals or follow-up appointments.
5. Writing prescriptions for medications, if needed.
6. Completing any other administrative tasks related to the patient’s discharge.

4. Qualifying circumstances

Patients eligible to receive CPT code 99238 services are those who are in the inpatient hospital or observation setting and require discharge day management services. The healthcare provider must spend 30 minutes or less on the date of the encounter to qualify for this code. The time spent does not need to be continuous.

5. When to use CPT code 99238

It is appropriate to bill the 99238 CPT code when the following conditions are met:

• The patient is in the inpatient hospital or observation setting.
• The healthcare provider performs evaluation and management (E/M) services related to the patient’s discharge.
• The total time spent on the date of the encounter is 30 minutes or less.

If the provider spends more than 30 minutes with the patient completing the patient’s discharge, use code CPT 99239, Hospital discharge day management; more than 30 minutes. If the provider admits and discharges the patient on the same day, use hospital care service codes from the evaluation and management services CPT 99234 to CPT 99236 rather than CPT 99238.

6. Documentation requirements

To support a claim for CPT 99238, the following information needs to be documented:

• Patient’s demographic information, including name, date of birth, and insurance information.
• Date of the encounter and the total time spent on discharge day management services.
• A detailed description of the evaluation and management (E/M) services provided.
• Continuing care instructions given to the patient and/or their caregivers.
• Discharge forms, referrals, and follow-up appointments, if applicable.
• Prescriptions written, if any.

7. Billing guidelines

When billing for CPT code 99238, it is essential to follow the appropriate guidelines and rules. Ensure that the patient meets the qualifying circumstances for this code and that the total time spent on the date of the encounter is 30 minutes or less. If the provider spends more than 30 minutes on discharge day management services, use CPT 99239 instead. For same-day admissions and discharges, use hospital care service codes from the evaluation and management services CPT 99234 to CPT 99236.

8. Historical information

CPT 99238 was added to the Current Procedural Terminology system on January 1, 1992. The code was changed on January 1, 2023, with the previous descriptor being “Hospital discharge day management; 30 minutes or less.”

9. Similar codes to CPT 99238

Five similar codes to CPT 99238 and how they differentiate are:

1. CPT 99239: This code is used for hospital discharge day management services when the provider spends more than 30 minutes on the date of the encounter.
2. CPT 99234: This code is used for hospital admission and discharge on the same day, with a total time spent of 40-50 minutes.
3. CPT 99235: This code is used for hospital admission and discharge on the same day, with a total time spent of 50-110 minutes.
4. CPT 99236: This code is used for hospital admission and discharge on the same day, with a total time spent of 110 minutes or more.
5. CPT 99217: This code is used for observation care discharge services, which are separate from inpatient hospital discharge day management services.

10. Examples

Here are 10 detailed examples of CPT code 99238 procedures:

1. A patient is discharged from the hospital after a brief stay for pneumonia. The provider spends 25 minutes on the date of the encounter reviewing the patient’s condition, providing continuing care instructions, and completing discharge paperwork.
2. A patient in the observation unit is discharged after a 24-hour stay for chest pain. The provider spends 20 minutes on the date of the encounter evaluating the patient’s condition, providing discharge instructions, and writing a prescription for medication.
3. A patient is discharged from the hospital after a two-day stay for cellulitis. The provider spends 15 minutes on the date of the encounter reviewing the patient’s medical records, providing continuing care instructions, and completing discharge forms.
4. A patient in the inpatient hospital setting is discharged after a three-day stay for dehydration. The provider spends 30 minutes on the date of the encounter evaluating the patient’s condition, providing discharge instructions, and writing a prescription for medication.
5. A patient is discharged from the hospital after a four-day stay for a urinary tract infection. The provider spends 10 minutes on the date of the encounter reviewing the patient’s condition, providing continuing care instructions, and completing discharge paperwork.
6. A patient in the observation unit is discharged after a 48-hour stay for abdominal pain. The provider spends 25 minutes on the date of the encounter evaluating the patient’s condition, providing discharge instructions, and writing a prescription for medication.
7. A patient is discharged from the hospital after a five-day stay for a respiratory infection. The provider spends 20 minutes on the date of the encounter reviewing the patient’s medical records, providing continuing care instructions, and completing discharge forms.
8. A patient in the inpatient hospital setting is discharged after a six-day stay for a gastrointestinal issue. The provider spends 15 minutes on the date of the encounter evaluating the patient’s condition, providing discharge instructions, and writing a prescription for medication.
9. A patient is discharged from the hospital after a one-week stay for a skin infection. The provider spends 30 minutes on the date of the encounter reviewing the patient’s condition, providing continuing care instructions, and completing discharge paperwork.
10. A patient in the observation unit is discharged after a 72-hour stay for dizziness. The provider spends 20 minutes on the date of the encounter evaluating the patient’s condition, providing discharge instructions, and writing a prescription for medication.