Wiki ICU Care & Inpatient consultation on same day

[neha.bhatnagar]

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.

 

[Salemcoder]

ICU / Consult

I think you would include the consult time in the CC codes, but you need to have a life-threatening dx -- at least one major organ failure. I probably would have not billed the consult since the 99291 was billed. We have had more 99291's denied lately because other specialties billed it on the same day. I will be interested in how others would bill this also.

 

[Jagadish]

Both are payable. But bill this way: Change the PDX for critical care to 434.91 instead of 436, which lacks the specificity for the critical illness, that gives the medical necissity for 99291 and reappeal.