Crital care Procedure code 99291

almag69

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Good Morning,


I have a few providers in my practice who document and bill out for critical care when they see patients in the hospital, I just want clarification that this would be the only code billed out for that day and we are not supposed to bill out the inpatient visit along with the critical care code. Can someone plaease calrify this for me, thank you. UHC has denied a critical care visit we are trying to figure out why.

Any help would be appreciated.
 

espressoguy

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Can't help you with why CC was denied as you didn't provide any specifics. However you can bill both an E&M and CC on the same day in limited circumstances. If the E&M occurs first and then later in the day the patient crashes requiring CC then CC is billable with a 25 on the E&M.
 

almag69

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Thank you for your reply UHC can not tell my biller what they are denying it for just that guidelines were not followed, it is not an initial visit and the patient did not crash later in the day so a separate E/M visit was not billed. The only other thing is another physician in our practice of a different specialty saw the patient on the same day. He also billed a critical care visit, again they are of two different specialties. I'm reading everything on critical care and it does not state that only on physician can bill for this service.
 

espressoguy

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Did this occur prior to 2016?

I was discussing a semi-related UHC issue with my supervisor today and, prior to 1/1/16 UHC did not recognize different specialties (or subspecialties) within the same group. So this might explain why your 99291 was denied when another provider within your group billed 99291 on the same day even though it was a different specialty.
 
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