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Consultation vs critical care

  1. #1
    Smile Consultation vs critical care
    Medical Coding Books
    We have a patient that was seen on 7/13 in consultation by one of our physicians. That evening, at 11:50 PM, another of our physicians spent 45 minutes caring for the patient in the ICU.

    We realize that we can only bill for one E/M visit per day.

    Since the visit began at 11:50 PM on 7/13 and ended at 12:35 AM on 7/14, can we bill the critical care visit as 7/14?

  2. #2
    assuming that all the documentation is correct, you can bill a consult and critical care on the same day, you would add the modifier 25. Based on CMS

    "A physician or qualified NPP consultant may initiate diagnostic services and treatment at the initial consultation service or subsequent visit. Ongoing management, following the initial consultation service by the consultant physician, shall not be reported with consultation service codes. These services shall be reported as subsequent visits for the appropriate place of service and level of service. Payment for a consultation service shall be made regardless of treatment initiation unless a transfer of care occurs."
    Also by CMS
    "When critical care services are provided on a date where an inpatient hospital or office/outpatient evaluation and management service was furnished earlier on the same date at which time the patient did not require critical care, both the critical care and the previous evaluation and management service may be paid."

  3. #3
    Milwaukee WI
    Default Two ways to do this
    I agree with mixitli ... you CAN code the consult for Dr A (with a -25 mod) and the Critical Care for Dr B both on DOS 7-13-09. (We usually use the date of service as when service began.)

    You CAN also decide to code Dr B's critical care on 7-14-09 since the vast majority of the service (and clearly more than 30 minutes) was provided on 7-14-09. But if anyone else saw the patient and provided critical care on 7-14-09, then you'll have to add that time to Dr B's time and code it together using 99291 and add-on 99292 once total time is over 75 minutes.

    Your call.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Thank you both! I appreciate the help, and so does my physician!

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