Coding Consult

February 17, 2006

Answers to your questions about...same day readmission; critical care; sunburn code

Same day discharge and readmission

A. Report the discharge service with 99238-99239 (hospital discharge day management . . .). For the same-day readmission, submit 99221-99223 (initial hospital care, per day, for the evaluation and management of a patient . . .) appended with modifier –25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). You need the modifier to distinguish that the admission is a significant and identifiable E&M service on the same day as the discharge. Code both the discharge and the admission linked to diagnosis code 493.01 (extrinsic asthma; with status asthmaticus).

Admission and critical care

Q. I spent 90 minutes providing critical care to a patient suffering from alcohol abuse, respiratory failure, renal failure, and sepsis. After providing the critical care services, I admitted him to the hospital. Should I report one or two E&M services?

A. One. Because you provided the critical care services before the admission, you should code only the critical care service. Assuming that your documentation supports that you spent 90 minutes providing critical care servces, submit 99291 (critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the first 74 minutes.

To capture the additional 16 minutes of critical care time, report add-on code 99292 (. . . each additional 30 minutes . . .). All other same-day E&M services, including the hospital admission (99221-99223, initial hospital care, per day, for the evaluation and management of a patient . . .), are bundled into the critical care services (99291-99292).

Be prepared to submit documentation to demonstrate that you rendered services at different times.

Sunburn coding

Q. After returning from vacation, a patient with blisters on his shoulders from sunburn came in for treatment. I cleaned the area and applied ointment and a dressing. Should I report the burn treatment with an E&M code?

A. No. Because you provided initial treatment of a burn, you should instead assign a burn treatment code. Select the appropriate code based on the burn's degree and treatment.

Because the deep sunburn, considered a second-degree burn, required a dressing, you should assign 16020 (dressings and/or debridement, initial or subsequent; without anesthesia, office or hospital, small [less than 5% total body surface area]). Link the burn code to the second-degree sunburn diagnosis code (692.76).

This information is adapted from material provided by the Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact the Coding Institute, 2272 Airport Road South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592 or visit http://www.codinginstitute.com.