CMS Pub. 100-04, ch. 12, § 30.6.9.2

Hospital Inpatient or Observation Discharge Day Management (Codes

99231 - 99239)

(Rev. 11842; Issued; 02-09-23 Effective:01-01-23; Implementation: 05-09-23)

A. Subsequent Hospital Inpatient or Observation Care Visits During the Global Surgery

Period

(Refer to §§40-40.4 on global surgery)

The Medicare physician fee schedule payment amount for surgical procedures includes all

services (e.g., evaluation and management visits) that are part of the global surgery payment;

therefore, A/B MACs (B) shall not pay more than that amount when a bill is fragmented for

staged procedures.

B. Hospital Inpatient or Observation Discharge Day Management Service

Hospital Inpatient or Observation Discharge Day Management Services, CPT code 99238 or

99239 is a face-to-face evaluation and management (E/M) service between the attending

physician and the patient. The E/M discharge day management visit shall be reported for the

date of the actual visit by the physician or qualified nonphysician practitioner even if the

patient is discharged from the facility on a different calendar date. Only one hospital inpatient

or observation discharge day management service is payable per patient per hospital stay.

Only the attending physician of record reports the discharge day management service.

Physicians or qualified nonphysician practitioners, other than the attending physician, who

have been managing concurrent health care problems not primarily managed by the attending

physician, and who are not acting on behalf of the attending physician, shall use Subsequent

Hospital Care (CPT code range 99231 - 99233) for a final inpatient hospital visit; practitioners

furnishing additional observation care services bill the appropriate office/outpatient code, per

section 30.6.8.B.

C. Subsequent Hospital Inpatient or Observation Visit and Discharge Management on

Same Day

Pay only the hospital inpatient or observation discharge management code on the day of

discharge (unless it is also the day of admission, in which case, refer to §30.6.9.1 C for the

policy on Hospital Inpatient or Observation Care Services (Including Admission and Discharge

Services CPT Codes 99234 - 99236). A/B MACs (B) do not pay both a subsequent hospital

inpatient or observation care visit in addition to hospital inpatient or observation discharge day

management service on the same day by the same physician. Instruct physicians that they may

not bill for both a hospital inpatient or observation care visit and hospital inpatient or

observation discharge management for the same date of service.

D. Hospital Inpatient or Observation Discharge Management (CPT Codes 99238 and

99239) and Nursing Facility Admission Code When Patient Is Discharged From Hospital

and Admitted to Nursing Facility on Same Day

A/B MACs (B) pay the hospital inpatient or observation discharge code (codes 99238 or

99239) in addition to a nursing facility admission code when they are billed by the same

physician with the same date of service.

If a surgeon is admitting the patient to the nursing facility due to a condition that is not as a

result of the surgery during the postoperative period of a service with the global surgical

period, he/she bills for the nursing facility admission and care with a modifier “-24” and

provides documentation that the service is unrelated to the surgery (e.g., return of an elderly

patient to the nursing facility in which he/she has resided for five years following discharge

from the hospital for cholecystectomy).

A/B MACs (B) do not pay for a nursing facility admission by a surgeon in the postoperative

period of a procedure with a global surgical period if the patient’s admission to the nursing

facility is to receive post operative care related to the surgery (e.g., admission to a nursing

facility to receive physical therapy following a hip replacement). Payment for the nursing

facility admission and subsequent nursing facility services are included in the global fee and

cannot be paid separately.

E. Hospital Inpatient or Observation Discharge Management and Death Pronouncement

Only the physician who personally performs the pronouncement of death shall bill for the face-to-face Hospital Inpatient or Observation Discharge Day Management Service, CPT code

99238 or 99239. The date of the pronouncement shall reflect the calendar date of service on

the day it was performed even if the paperwork is delayed to a subsequent date.