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Critical Care & Initial Inpatient ??Help??

  1. #1
    Default Critical Care & Initial Inpatient ??Help??
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    Doc does initial inpatient and codes 99223 and has proper documentation for the level. 2 hours later the doc see patient and notes chart that he spent 30 minutes. The doc bills 99291 for this service. The doc discharges the patient the next day. I do not want to allow the 99291 because the documentation does not indicate it is a life threatening. Can this doc report prolonged service since he spent 30 minutes extra that day, or does the doc have to have total time of both visits documented. Is this second visit of the day not able to be reported?


  2. #2
    Default Critical Care & Initial Inpatient
    The 99233 Initial Inpatient visit has a 'typically spend 70 minutes" time allowance so in order to be able to determine prolonged service for an inpatient service (99356), a total time of the initial encounter and the second encounter on the same date of service would have to total at least 110 minutes. ( 70 min + at least 30-60 min). Without the total time of both visits being documented, there isn't anything you can base the additional prolonged service code. Be sure to educate your physician on the importance of documenting time. Refer to the coding guidelines at the beginning of the prolonged service codes for additional details on the use of these codes.

  3. #3
    Thanks so much, that is exactly what I thought!!!

  4. #4
    Milwaukee WI
    Default Not so fast ...
    Actually if the original visit documentation meets all the bullets required for the level of service, you do NOT need to have the time for that service.

    The only situation in which you would need the total time of both services is if you were using time spent in counseling/coordination of care to determine your level of Initial hospital visit, and then, yes, you'd need at least 110 total minutes to get any prolonged service.

    I'd query the doctor about the 99291 visit. What about the patient's condition made the doctor decide the patient was critically ill? What about the physician-provided care qualified as critical care? The words "life threatening" don't have to be in the documentation exactly for the patient to be critically ill.

    However, if these questions cannot be satisfactorily answered/documented, then you can use the prolonged service code for this additional service on that date of service. (The fact that the patient was well enough for discharge the next morning makes me think you may be right - the patient wasn't critical.)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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