ICU billing codes

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Hi, we are just wondering if doctors admitted a patient in the ICU - what proper codes do we use for admit, initial visit and subsequent visits? Will help us tremendously before we submit charges. Thank you. :confused:
 
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Milwaukee WI
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Depends

This depends on the documentation and on whether the admitting physician is also a surgeon who is performing a procedure with a global period.

There are too many variables to give you a definite answer.

F Tessa Bartels, CPC, CEMC
 
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Hi F Tessa =)... Thank you - the dr. is a family practitioner who admitted patient through ER and patient had pneumonia and other critical issues. He then went for an initial visit the following day and patient was at the ICU and Dr. saw him for 4 days in the ICU and 4 days later he was transferred to the regular floor and was discharged on the 9th day by the same dr.

I have never billed an ICU visit. All your help and experience will be helpful. Thank you =).
 

dpumford

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Just because a pt is in ICU does not mean you bill critical care. If he was the admitting physician you would bill the 99221-99223 with AI mod . You would bill the follow up visit as subsquent care days 99231-99233. Location does matter.

Hope this helps!!
 
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ICU billing

Dpumford is partially correct - just because the patient is in the ICU does not mean that your physician provided critical care.

However, it also doesn't necessarily mean that because your physician admitted the patient s/he did NOT provide ciritcal care. In fact, if the admitting physician provided critical care for 30 or more minutes, then I would use 99291-99292 instead of the 99221-99223 codes; I would NOT use both.

Everything depends on the documentation.

If the patient was critically ill, and the physician provided critical care - regardless of location of the care, or the specialty of the physician - then it is appropriate to use the critical care codes.

Without seeing all the notes I could not tell you for certain what codes your documentation support.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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