AAPC - Back to school
Results 1 to 3 of 3

Thread: Billing Critical Care ER and ED E&M Same Day

  1. #1
    Join Date
    Apr 2007

    Default Billing Critical Care ER and ED E&M Same Day

    AAPC: Back to School
    Scenario: Patient is seen in ER and physician wants to admit, but patient refuses and leaves- coded as a 99285. Later in day, patient returns to ER and is ultimately admitted and this visit is coded as a 99291. For proper billing, does a 25 mod need be applied? And if so, which code gets the mod - Critical Care 99291 or ED code 99285?

  2. #2


    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.

    Per ACEP:
    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.
    Last edited by Mojo; 05-11-2011 at 08:44 PM. Reason: Unable to access ACEP.org for reference on 5/10/11.

  3. #3
    Join Date
    Apr 2007


    I am not an expert. But still I will try this.

    1) Do not need mod 25 for any visit

    2) I assume if the patient came and left and came back at night time by the time they admit it will be the next day ( after 12 pm).

    In that case I think the ED visit (1st visit) can bill seperately.


    everything comes under one day you may bill with modifier 27 for second visit provided with supporting documentation for both visits.

    I will wait for response from others

Similar Threads

  1. Critical care and anesthesia same day
    By smeetze in forum Anesthesia
    Replies: 2
    Last Post: 02-26-2016, 02:26 PM
  2. Critical Care & Discharge Same Day?
    By jocarter in forum Internal Medicine
    Replies: 3
    Last Post: 11-12-2013, 09:48 AM
  3. Replies: 2
    Last Post: 05-18-2012, 04:01 PM
  4. Critical Care and ED Same Day
    By sparkles1077 in forum Emergency Department
    Replies: 4
    Last Post: 04-28-2010, 03:17 PM
  5. Consultation & Critical care on same day-Pls help
    By neha.bhatnagar in forum Family Practice
    Replies: 3
    Last Post: 06-13-2009, 06:07 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?


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.