Skip to Main Content
Issue Number - Name
0149-Subsequent Hospital Visit and Discharge Day Management Billed on Same Day
Review Type
Automated
Claim Type
Professional Services
Region and State
RAC 1-4
All Regions
Date Approved
03/05/2019

Description

Per Medicare Claims Processing Manual Chapter 12, Section 30.6.9.2 (C), A/B MACs (B) do not pay both a subsequent hospital visit in addition to hospital discharge day management service on the same day by the same physician

Affected Codes

99231-Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of 3 key components; a problem focused interval history, a problem focused examination and/or medical decision making that is straightforward or low complexity usually the patient is stable, recovering or improving. Typically, 15 minutes are spent at the bedside and one the patient's hospital floor or unit.                 

99232-Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of 3 key components; an expanded focused interval history, an expanded problem focused examination and/or medical decision making of moderate complexity. Usually the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and one the patient's hospital floor or unit.                             

99233-Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of 3 key components; a detailed interval history, a detailed examination and/or medical decision making of high complexity. Usually the patient is unstable or has developed a significant complication. Typically, 35 minutes are spent at the bedside and one the patient's hospital floor or unit.

Applicable Policy References

Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)-Exclusions from Coverage and Medicare as a Secondary Payer
Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1833(e)-Payment of Benefits
42 CFR, Section 405.980-Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)-Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor;  and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
42 CFR, Section 405.986-Good Cause for Reopening
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.9.2(C) Subsequent Hospital Visit and Discharge Management on Same Day