Wiki Inpatient consult/critical care same day

[kimsue63]

Can't seem to find a documented answer for this question.... we bill for a pediatric intensivist who is billing a consult and critical care on same date. If this was, in fact, one visit in which he was asked to see the patient and then proceeded to spend 2 hours critical care time on him/her, would it only be the critical care? Am I correct that if he is asked to consult in the morning and then sees the patient again later in the day that he could bill for both? Just want verification that I am correct, or not?

 

[kimsue63]

Does anybody have any input on this at all? Any feedback is appreciated.

 

[OCD_coder]

First, we need to be sure there are two separate reports for each service. and both meet the criteria and pay attention to the carrier's the services are reported to. We will assume for the purpose of answer you question the patient accepts consult codes. Second, you would be correct if the provider performed a consult first and earlier in the day, completed his care/treatment plan and left the hospital/floor and then was asked to come back as the patient "went critical" later in the day. Both would be billable services.

In reverse, if the patient was first seen and critical care was performed first, then later in the day was asked to consult the answer would be no. Remember only one provider at a time can perform critical care. So if the specialist is not directing critical care, but maybe the hospitalist is, then critical care cannot be billed for both providers even if they are different Tax ID's.

A tricky scenario, but doable when the documentation supports the work.