Critical Care coding question

[cnramsey]

Can I charge a 99232 f/u inpatient with 99291 critical care?

Nichole

[jimbo1231]

You can if the patient becomes unstable with potenital for organ failure, deterioration or death. There must be documentation of the clinical situation that required CC, physician interventions etc.Also 30 minutes of CC time must be documented. But CC can be in any hospital setting. Take a look at the CPT book for more details.

Jim Strafford CEDC MCS-P

[j.berkshire]

Only if the visit was provided earlier in the day than the CC. See the Medicare Claims Processing Manual, Chapt. 12, Section 30.6.12.H (http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf) which states:
"When critical care services are provided on a date where an inpatient hospital or office/outpatient evaluation and management service was furnished earlier on the same date at which time the patient did not require critical care, both the critical care and the previous evaluation and management service may be paid."

[sherryjean27]

Does anytone else have any info on this. I thought cc could be billed with an e&m as long as that time is seperate than the cc time. Because actually the e&m is done earlier on the same date (right before the cc, for example).

Originally Posted by j.berkshire

only if the visit was provided earlier in the day than the cc. See the medicare claims processing manual, chapt. 12, section 30.6.12.h (http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf) which states:
"when critical care services are provided on a date where an inpatient hospital or office/outpatient evaluation and management service was furnished earlier on the same date at which time the patient did not require critical care, both the critical care and the previous evaluation and management service may be paid."

[FTessaBartels]

If your subsequent hospital visit is done immediately prior to critical care, I would not code it ... sounds to me like the entire visit would be critical care.

The intention of allowing you to code the subsequent hospital visit AND also critical care on the same date of service is to allow for those situations where a patient is stable when seen earlier in the day, but has subsequently deteriorated to the point where the patient is critically ill and critical care is required.

Hope that helps.

F Tessa Bartels, CPC, CEMC