Medicare, and only Medicare from my experience, allows reimbursement of a problem visit on the same date as a preventive visit only because a portion of the total visit is covered by Medicare; that being the problem visit. The provider could/should "carve out" the problem visit charge from the preventive visit charge and bill the patient for the difference. This is a special circumstance due to Medicare's non-coverage of preventive care. (Only one E/M is actually reimbursed.)
It is not the same situation for critical care and discharge care. Two evaluation and management charges for one date of service simply is not allowed.
And to answer your question with another question ... generally E/M assisgnment is based on where the patient ends up. So wouldn't discharge care be most appropriate???
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