Consultation & Critical care on same day-Pls help

neha.bhatnagar

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Hi Friends,

Hope you help me with this !

Our provider did an inpatient consultation for a patient. On same day she also provided critical care of 2 hrs on same day for that patient.

We have coded the case like this :
99254.25 - 780.2, 780.4
70450.26 - 780.2, 780.4
99291 - 436, 438.21
99292 - 436, 438.21

Tha critical care services got denied saying not medically necessary.

What is the correct way of billing ? How we can get paid for extra time spent by physicain for critical care ?

Thanks.
Neha Bhatnagar, CPC, CPC-H
 

mitchellde

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I think your dx codes are wrong just looking at them they do not make sense to me... can you tell me the reason for the consult, the procedure and the critical care?
 

rthames052006

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York, Pa
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Hi Friends,

Hope you help me with this !

Our provider did an inpatient consultation for a patient. On same day she also provided critical care of 2 hrs on same day for that patient.

We have coded the case like this :
99254.25 - 780.2, 780.4
70450.26 - 780.2, 780.4
99291 - 436, 438.21
99292 - 436, 438.21

Tha critical care services got denied saying not medically necessary.

What is the correct way of billing ? How we can get paid for extra time spent by physicain for critical care ?

Thanks.
Neha Bhatnagar, CPC, CPC-H
Have you tried calling this particular insurance carrier? Have you submitted the physician's critical care notes for a redetermination? These two things is what I would do first. Prior to sending off any records review them and make sure the time is documented. Then go from there.
 

mitchellde

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Columbia, MO
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I agree with what Roxanne has said, however I still believe the not medically necessary denial stems from the dx.. You have an acute but ill define cv disease code and a late effect cv code attached to a critical care service. The dx codes do not really support a critical care service. What does the documentation state as the reason the physician administered critical care and was the time documented..
 
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