Results 1 to 8 of 8

Critical Care

  1. #1
    Default Critical Care
    Exam Training Packages
    When performing Critical Care on the same day as an inpatient consultation, do you bill both the consultation and the critical care codes? (I have my own opinion on this, but my manager wants me to see what other practices do in this scenario)

  2. #2
    Default
    Quote Originally Posted by Colliemom View Post
    When performing Critical Care on the same day as an inpatient consultation, do you bill both the consultation and the critical care codes? (I have my own opinion on this, but my manager wants me to see what other practices do in this scenario)
    Critical care is its own thing, and can be reported separately. The usual site of service hierarchy, doesn't apply. Per CPT guidelines, "Critical care and other E/M services may be provided to the same patient on the same date by the same physician." (page 21)

  3. #3
    Location
    Richmond, VA
    Posts
    75
    Default
    Quote Originally Posted by Colliemom View Post
    When performing Critical Care on the same day as an inpatient consultation, do you bill both the consultation and the critical care codes? (I have my own opinion on this, but my manager wants me to see what other practices do in this scenario)

    The way we handle that situation -
    if there are two separate notes/diagnoses that show why the physician had to come back and later provide critical care, then we would bill both and be reimbursed for both.
    If it was for the same reason, then I would argue that you only bill one, the critical care. I've found that we don't get reimbursed for two E/M codes, even critical care and something else, if the primary diagnoses/documentation are for the same reason.
    Annemarie Lincoln, CPC
    Richmond, VA

  4. #4
    Default
    Quote Originally Posted by alincoln View Post
    The way we handle that situation -
    if there are two separate notes/diagnoses that show why the physician had to come back and later provide critical care, then we would bill both and be reimbursed for both.
    If it was for the same reason, then I would argue that you only bill one, the critical care. I've found that we don't get reimbursed for two E/M codes, even critical care and something else, if the primary diagnoses/documentation are for the same reason.
    If the critical care and consult happened simultaneously, then that would indicate that the patient had already lapsed into a 'critically ill' status, at the time they were consulted, and the doctor was merely assisting in the critical care of the patient. If that's the case, then no, don't bill a separate consult. But, if the two occurred independently, you should be able to be reimbursed with both, but probably only after sending an appeal with records showing that the incidences didn't occur at the same time.

    Don't forget, to be considered a true "consultation", you must have 2 things documented:
    1. A request for a doctor's professional opinion, regarding the patient's condition, or plan of treatment, from a qualified source
    2. The consulting MD's written report with recommendations, sent back to the requestor.

    And Medicare doesn't cover consult codes, so use an inpatient hospital code, instead, for them.

  5. #5
    Location
    Richmond, VA
    Posts
    75
    Default
    Thanks Brandi! You typed what was I trying to get across in a much clearer way :-)
    Annemarie Lincoln, CPC
    Richmond, VA

  6. #6
    Location
    Baton Rouge
    Posts
    1,239
    Default
    Quote Originally Posted by alincoln View Post
    Thanks Brandi! You typed what was I trying to get across in a much clearer way :-)
    Brandi seems to be really good at that!
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  7. #7
    Default
    Quote Originally Posted by mhstrauss View Post
    Brandi seems to be really good at that!
    Thanks!

  8. #8
    Location
    Richmond, VA
    Posts
    75
    Default
    Quote Originally Posted by mhstrauss View Post
    Brandi seems to be really good at that!
    Yes she is :-)
    Annemarie Lincoln, CPC
    Richmond, VA

Similar Threads

  1. E&M Critical Care and Subsequent Hospital Care
    By abbyakinleye in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 04-10-2016, 02:51 PM
  2. Replies: 2
    Last Post: 05-18-2012, 05:01 PM
  3. Replies: 11
    Last Post: 02-21-2011, 12:06 PM
  4. Replies: 4
    Last Post: 10-19-2010, 10:37 AM
  5. Newborn Care and Neonate/Pediatric Critical Care
    By bobbro in forum Pediatrics
    Replies: 1
    Last Post: 03-03-2009, 04:35 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.