Question Billing critical care on an inpatient

[mwells2020]

Can someone tell me if you have ever billed critical care on an Inpatient? We recently had a patient that needed transferred out. The provider is wanting critical care billed. We are a Critical Access Hospital. Can I bill critical care instead of the Acute d/c code?

 

[thomas7331]

Yes, per the guidelines critical care may be reported in any place of service where it is performed. In my experience, inpatient is usually the most common place for critical care. It can be billed if the documentation meets all of the requirements.

 

[mwells2020]

Have you ever billed the E&M along with the critical care?

 

[thomas7331]

Have you ever billed the E&M along with the critical care?

I don't recall a situation where I've had to bill this, but it is allowed per guidelines. See the Medicare Claims Processing Manual, Chapter 12: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf

Per section 30.6.9:
"Hospital evaluation and management (E/M) visits may be billed the same day as critical care services in certain circumstances discussed in section 30.6.12. Documentation must support the claims as indicated in that section."

and section 30.6.12.6:
"in situations where a patient receives another E/M visit on the same calendar date as critical care services, both may be billed (regardless of practitioner specialty or group affiliation) as long as the medical record documentation supports: 1) that the other E/M visit was provided prior to the critical care services at a time when the patient did not require critical care, 2) that the services were medically necessary, and 3) that the services were separate and distinct, with no duplicative elements from the critical care services provided later in the day. Practitioners must use modifier -25 (same-day significant, separately identifiable evaluation and management service) on the claim when reporting these critical care services."

 

[mwells2020]

Thank you so much for your help! I really appreciate it!