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

 

[Vdudala]

I think in this case the Dx codes should not have been repeated with the add-no code.
I am not sure about it, this is what I think.
As to let you know, I am new to coding and preparing to my CPC exam.
Have a nice time.

 

[mitchellde]

You have an acute but ill defined cerebral vascular disease coupled with a late effect from CVA code as the medical necessity for critical care. Neither of the dx codes indicates the need for critical care. What was the dx as given as the need for the critical care. Just because the patient is in an ICU setting does not automaticall equal critcal care service. Can you post the note from the critical care event?