Results 1 to 4 of 4

Need an Inpateint Expert

  1. #1
    Default Need an Inpateint Expert
    Exam Training Packages
    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
    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
    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
    Location
    Milwaukee WI
    Posts
    4,466
    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

Similar Threads

  1. Expert help please
    By CRC CPC in forum General Surgery
    Replies: 2
    Last Post: 08-24-2010, 02:16 PM
  2. Discharge Inpateint, Admit to Hospice
    By randiroyder in forum E/M
    Replies: 2
    Last Post: 01-29-2009, 09:49 AM
  3. expert please
    By daniel in forum Cardiovascular Thoracic
    Replies: 2
    Last Post: 08-19-2008, 10:49 PM
  4. I need E/M expert. PLEASE. ?????
    By daniel in forum E/M
    Replies: 13
    Last Post: 08-07-2008, 04:25 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.