Hospital discharge day management, 30 minutes or less
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Missing discharge time documentation
Very CommonHospital discharge day management (99238) requires 30 minutes or less total time. More than 30 minutes uses 99239. Most common denial: discharge time not documented, preventing verification of time-based code selection. Must document: discharge orders time, final exam, discharge instructions time, total time spent. Cannot bill discharge day management if patient dies or leaves against medical advice.
Common Causes
- • No discharge time documentation (required for 99238 vs. 99239 selection)
- • Discharge summary completed days later, not on discharge day
- • Missing final examination documentation
Resolution Strategy
Provider adds discharge day documentation: final exam findings, discharge time, total time spent coordinating care and preparing discharge. Most payers accept appeals with proper time documentation. If >30 minutes, may upgrade to 99239.
Relative Value Units (RVUs)
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Clinical Information
When to Use
Final hospital discharge examination, instructions, and prescriptions
Common Scenarios
Documentation Requirements
- Final examination on discharge day
- Discharge instructions and prescriptions
- Discussion of hospital course with patient/family
- Coordination of follow-up care
- Preparation of discharge records
Coding Guidelines
Common Modifiers
Bundling Rules
- Cannot be billed with subsequent hospital care codes on same date
- Cannot be billed with admission codes (same-day admit/discharge use 99234-99236)
- Includes all discharge-related activities on that date
Exclusions
- 99234-99236 (observation or inpatient same date admission/discharge)
- 99231-99233 (subsequent hospital care codes)
- 99239 (discharge management >30 minutes)
Coding Notes
Clinical scenarios
- Final examination on discharge day
- Discharge instructions and prescriptions
- Discussion of hospital course with patient/family
- Final examination on discharge day
- Discharge instructions and prescriptions
- Discussion of hospital course with patient/family
- Final examination on discharge day
- Discharge instructions and prescriptions
- Discussion of hospital course with patient/family
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Code Details
Medicare Pricing
PFSRVU Breakdown
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Frequently Asked Questions
CPT 99238 is the billing code for "Hospital discharge day management, 30 minutes or less". Final hospital discharge examination, instructions, and prescriptions
Medicare pays approximately $78.28 for CPT 99238 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 99238 has a total RVU of 2.66, broken down as: Work RVU 1.66, Practice Expense RVU 0.88, and Malpractice RVU 0.12. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 99238 is "Missing discharge time documentation". Hospital discharge day management (99238) requires 30 minutes or less total time. More than 30 minutes uses 99239. Most common denial: discharge time not documented, preventing verification of time-based code selection. Must document: discharge orders time, final exam, discharge instructions time, total time spent. Cannot bill discharge day management if patient dies or leaves against medical advice. Common causes include: No discharge time documentation (required for 99238 vs. 99239 selection); Discharge summary completed days later, not on discharge day. Appeal success rate is approximately 70-80%.
Key documentation requirements for CPT 99238 include: Final examination on discharge day; Discharge instructions and prescriptions; Discussion of hospital course with patient/family; Coordination of follow-up care. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 99238: Cannot be billed with subsequent hospital care codes on same date. Cannot be billed with admission codes (same-day admit/discharge use 99234-99236) Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 99238 include: AI (Principal physician of record), 52 (Reduced services if minimal discharge work). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 99238 is 30 minutes or less spent on discharge day activities. Time-based codes require documentation of the actual time spent providing the service.