Per CMS: Hospital emergency department services are not payable for the same calendar date as critical care services when provided by the same physician to the same patient.
FAQ 7. Can a critical care service code be reported with an E/M code for a Medicare patient cared for by the same physician on the same calendar day?
CMS Transmittal 1548 specifically addresses this question with regard to the emergency department. It states that when critical care services are required upon arrival into the emergency department, only critical care codes (99291-99292) may be reported. An emergency department E/M code (99281-99285) may not also be reported.
Although CMS understands that a patient may need critical care services on the same day where the patient may have only required an inpatient or office/outpatient E/M service earlier in the day, Transmittal 1548 clearly states that hospital emergency department services are not payable for the same calendar date as critical care services when provided by the same physician (which includes any physician of the same specialty in the same group) to the same patient.
In other words, if a Medicare patient presents to the emergency department and receives a Level 5 ED E/M workup, and later in the shift unexpectedly clinically deteriorates requiring critical care services, according to CMS the "same" ED physician can only report either the ED E/M service or the critical care service -- but not both.
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