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Can the Emergency Medicine physicians bill out an Emergency Dept. Visit code along with a Critical Care Visit code? If the answer is yes, what are the requirements and how should they be coding these encounter/services
"In a reversal of previous Medicare policy, you can now bill for both an E/M service AND a critical care service on the same date of service when a patient comes into the emergency department for an E/M, then crashes suddenly and requires critical care."
This was from a Coder's Pink Sheet article from July 08'.
Keep in mind Critical Care codes are time based and the physician needs to document how much time was spent in critical care. 99291 for the first 30 to 74 minutes then 99292 after that for each additional 30 minutes. Refer to your CPT book for further information also.
I looked into this for someone yesterday. Here's what I found from CMS's manual:
30.6.9 - Payment for Inpatient Hospital Visits - General
(Rev. 2282, Issued: 08-26-11, Effective: 01-01-11, Implementation: 11-28-11)
A. Hospital Visit and Critical Care on Same Day
When a hospital inpatient or office/outpatient evaluation and management service (E/M) are furnished on a calendar date at which time the patient does not require critical care and the patient subsequently requires critical care both the critical Care Services (CPT codes 99291 and 99292) and the previous E/M service may be paid on the same date of service. Hospital emergency department services are not paid for the same date as critical care services when provided by the same physician to the same patient.
I just did a webinar on this topic. Depends on the payer for your answer. Per CPT, you can bill an e/m and a CC service on the same DOS. You need to append a 25 modifier to the e/m if provided on the same DOS. Only restrictions are for Medicare patients. Medicare does not accept ED visits and CC services on the same DOS, but they would accept other e/m codes. Then the CC service must occur AFTER the seperately billed e/m, not before.
He did state the critical care time, but he also wants to bill an admit. i am wondering if he would need two different documents, seperating them or can the CC time be at the end of his H/P for the admit?
From the sound of what you are saying (Only H&P referencing CC) the pt arrived critical. If that is the case the no he cannot bill the admit. One way to establish the status of the pt on arrival is to see if a trauma alert was called. It would be in the physicians best interest to add an addendum to his H&P that outlines the reason for the critical care. I would also request that he time reference the cc in the addendum (not the amount of time but the actual time, like 7 to 9 pm).
He is going to need to establish that his initial H&P and the CC did not occur during the same session.