Wiki Critical Care and Initial hosp care same day


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Can anyone advise me as to whether you can bill for Critical care and initial hosp care on the same day? Pt went to ER to critical care, then admitted to hosp? Can you bill for 99291 and 99223 on the same day by the same provider?
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You can't get paid for both

You won't get paid for both. I would recommend coding only for the Critical Care if that is documented appropriately.

Hope that helps.

F Tessa Bartels, CPC, CEMC
You can bill both, but only is pt was admitted first, and then later needed the critical care. I don't think this was the scenario you presented though. (but for future reference! :D)

i just found this on our MAC site in the Q&A:

Q7. A patient presents to the emergency room. The physician provides ED services and admits the patient. The patient is getting ready to be transferred to the floor when they crash. The physician has provided ED, initial hospital, and critical care services on this same day. What can the physician bill?
A7. When critical care and ED services are provided on the same date, only critical care services may be billed. In the example, the physician provided initial hospital services and then provided critical care services. If the documentation shows the break in services and the change in the patient's condition, both the initial hospital visit and the critical care services may be billed. If there is no break in services, bill the critical care services. Please let us know that you have additional documentation available using the narrative portion of the electronic claim. For more information, see CMS IOM Publication 100-04, Chapter 12, Section 30.6.12.H.