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Thread: Need an Inpateint Expert

  1. #1
    Join Date
    Apr 2007

    Default Need an Inpateint Expert

    AAPC: Back to School
    I was thinking, you know how in the office setting a physician can use a preventive E/M w/a Problem oriented E/M when that type of service is warrented.

    Well, when a physician in the inpatient setting is doing Critical Care to a patient and the patient Expires during that encounter.

    Why can't we use the Criitical Care CPT Code in addition to the Discharge management CPT code with modifier 25. They are two different distinct E/M.

    Can someone clear this up for me.

    I read in the Medicare Guidelines that a Subsequent visit can't be billed with a discharge management code. And that makes sense, but they say subsequent E/M not Critical Care.

    Help, Help

    Daniel, CPC

  2. #2
    Join Date
    Apr 2007

    Default preventive/problem visit vs critical care/discharge

    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???

  3. #3
    Join Date
    Apr 2007

    Default Thank You

    As for the discharge being coded vs the Critical Care.
    I see where your going with that.

    But you can bundled the time spent dealing with the Expired patient into the Critical Care when that type of visit is warrented.

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default Critical Care vs Discharge

    In our practice, we code critical care if documentation supports that ... even on day of death.

    If documentation does not support critical care, we code the discharge.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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