Primary Care Coding Alert

Heed this warning: Medicare mentions -discretionary reviews- on 99291 claims You-ll need to be sure that your critical care-E/M combo claims satisfy the criteria set forth in transmittal 1545; CR 5792 explains more clearly when you can -- and when you cannot -- code an E/M and critical care on the same date. Medicare just released more guidance on coding critical care on the same date as other E/M services. MLN Matters change request 5792 is a clarification of transmittal 1545, which came out earlier this summer. Remember to Separate E/M, Critical Care Minutes The article states that you can bill critical care and an E/M on the same date of service, which is news to a lot of coders. "I have never known Medicare to pay for subsequent visits on the same date" as critical care, states one anonymous coder. This, however, is actually a clarification of previous Medicare literature, says Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc. in Lansdale, Pa. The article also states that "critical care management of a patient whose services do not meet the level of critical care should be reported using an inpatient hospital care service with CPT codes for subsequent hospital care (99231-99233)." This means that if the FP provides the same patient hospital care and critical care on the same date, you-ll have to carve out the critical care time. Check out this example: At 9 a.m., the FP comes to the hospital to visit a patient suffering from cardiac arrhythmia. He speaks with the patient about how he's feeling, checks labs and adjusts medications. Notes indicate a level-two hospital service. At 11:30 a.m. the same day, the patient suffers cardiac arrest, and the FP returns after the patient has been resuscitated to provide 63 minutes of critical care for management of paroxysmal ventricular tachycardia and acute pulmonary edema secondary to idiopathic cardiomyopathy. You should be able to report the hospital visit and the critical care for this patient, provided the FP meets all the guidelines for both services, says Leslie Bowers, coder at Bay Ocean Medical in Tillamook, Ore. On the claim, you would report: - 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care - 427.1 (Paroxysmal ventricular tachycardia) appended to 99291 to represent the tachycardia - 425.4 (Other primary cardiomyopathies) appended to 99291 to represent the cardiomyopathy - 428.1 (Left heart failure) appended to 99291 to represent the acute pulmonary edema with heart failure - modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) appended to 99291 to show that it was [...]