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Thread: ICU Care & Inpatient consultation on same day

  1. #1

    Smile ICU Care & Inpatient consultation on same day

    AAPC: Back to School
    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 ?

    Neha Bhatnagar, CPC, CPC-H.

  2. #2
    Join Date
    Apr 2007
    Salem Oregon

    Thumbs down 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.

  3. #3


    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.
    Jagadish, CCS-P, CPC

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