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Pls help ASAP :-)

  1. #1
    Default Pls help ASAP :-)
    Medical Coding Books
    Can a physician bill a level 5 hospital day visit (it meets criteria) and a critical care (dr. spent 40 mins in Er) code on the same day if a patient is seen more than once but different level of care? I appreciate your help!!
    Laurie

  2. Default
    Critical is coded separately from any other E&M service provided that day as long as CC guidelines are met. Must document CC time. See the CPT guidelines right before the 99291-99292 codes

  3. #3
    Default level 5 hospital visit
    Quote Originally Posted by NJcoder View Post
    Can a physician bill a level 5 hospital day visit (it meets criteria) and a critical care (dr. spent 40 mins in Er) code on the same day if a patient is seen more than once but different level of care? I appreciate your help!!
    Would this be a level 5 consult code?
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  4. #4
    Default
    No, hospital visit, is that ok?
    Laurie

  5. #5
    Default
    if you have an e/m and a critical care on the same day, the e/m is first it requires a 25 modifier.

  6. #6
    Default
    Quote Originally Posted by NJcoder View Post
    No, hospital visit, is that ok?
    There is no level 5 hospital visit code, unless your speaking of a consult code. The other poster is correct in stating that actual e/m 99231-99233 would need the modifer added if billing critical care along w/ a subsequent hospital visit.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  7. #7
    Default
    My mistake, i meant he met the criteria for level 3 hospital visit.

    He was seen in ICU (critical care) then pat. became stable & Dr. also provided an inpatient hospital visit.

    So, we can bill both e/m services? Modifier 25? Or is there another modifier?
    Laurie

  8. #8
    Default
    What, other than change in POS from ER to IP, are you relying on to determine that the second block of time is not an extension of the CC services? different Dx?

    Definately EM and CC can be billed on the same day. But to my understanding, you would need the end of the life threatening situation and a new reason for the patient contact to justify the EM. Especially in this case where the EM comes after the CC.

    Pt seen in the morning to r/o gallstones generating an EM. Later in the day in a car accident and CC codes used. EM & CC

    Pt seen in the morning after car accident in ER given CC care. Later in the day, pt is stable and seen to r/o gall stones. CC & EM

    (examples are a little out there for clarity)

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