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Consult ER then Critical Care 29 days

  1. #1
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Question Consult ER then Critical Care 29 days
    Medical Coding Books
    29 day old infant brought to ER by ambulance. ER Doc evaluates,calls MD on call (pt PCP), can I use consult code w/critical care codes?
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Was child admitted?
    I', not sure why you'd want to bill both, as the critical care fees are quite high, include many services, and are reimbursed quite well.

    Our practice protocol would be to bill ONLY for the Critical Care charge.

    In any case, I can't tell from your description ... was the child admitted?

    If YES, and the PCP was the admitting physician who assumed overall care of the baby, then the PCP would probably only bill CPT 99293 (Initial inpatient pediatric critical care). This can only be billed once per day, but it is a pretty "all-inclusive" fee and is reimbursed quite well.

    If the patient was only seen in the ER ... it would depend on the documentation. You would bill 99291-92 as appropriate based on time spent caring for the critically ill patient in the ER.

    F Tessa Bartels, CPC-E/M

  3. #3
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default Critical Care Codes
    Pt was brought into the ER by ambulance. ER Doc called MD on call to consult on pt. She was severly obstructed bowel, dehydrated. Er Doc tried to put in IO line w/o success. On call MD arrived at ER request tried another IO line w/o success and tried again with success. Was medflighted out d/t critical
    condition of the child on the same day.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Crit Care plus IO
    Karen,
    I'd bill 99291-92 based on time documented in chart; if the line insertion is not included with the critical care code, I'd add -25 modifier to critical care and bill the line procedure as well.
    F Tessa Bartels, CPC-E/M

  5. #5
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default Critical care and IO
    Thank you for that information. I did not realize that a 25 was needed..
    Karen Barron, CPC
    Hampton New Hampshire Chapter

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