# hospital charges - I am unsure of how to bill for a hospital charge



## rianne831 (Jul 21, 2008)

I am unsure of how to bill for a hospital charge.  The patient was admitted (prolonged services), then patient collapsed and expired later that afternoon. I could only bill for an admit code w/prolonged services right? even tho the dr did a death summary, i cannot bill for a discharge on the same day correct? please help!!!!!!!!!!!


----------



## Herbie Lorona (Jul 22, 2008)

If they are admitted and discharged the same day you should use 99234 - 99236


----------



## MANCODER (Dec 4, 2008)

*Hospital codes H&P + additional encounter*



rianne831 said:


> I am unsure of how to bill for a hospital charge.  The patient was admitted (prolonged services), then patient collapsed and expired later that afternoon. I could only bill for an admit code w/prolonged services right? even tho the dr did a death summary, i cannot bill for a discharge on the same day correct? please help!!!!!!!!!!!



If your physician was involved in the care of the patient when the patient was in rapid response/code blue etc....you can code 99291(critical care service) +(see time chart for time increments) + any critical code procedures such as CPR or Intibation, line placement- pneumo thorax etc, bronoscopy. PLEASE READ the terms regarding CRITICAL CARE. It MUST be service that is rendered in the fact it is immenant-life sustaining management and care or in the effort to keep a pt from becoming emergent such as organ failure. It is in CPT guidelines for E/M it does not need to be performed in CCU or ICU or ER it could be in the hospital parking lot HOWEVER the performing physician MUST DOCUMENT time spent on critical care services. It will not be considered with out that most important element. No real documentation to qual for ie hx exam etc. Just the facts of why it was performed and supportive information as to why things were performed! Physicians, at least most I see over rate the need for Critical Care as I work for hospitalists and Intensivists. Most think that because they are in ICU its critical care. That is not correct! You must show a medically  necassary need to act at the highest level of medical performance and desicion process. This time can include dicussion with family about DNR/prgnosis, cordination of care and documenting the facts. But no other pt involvement can be counted or appearance away from the immediate area of the pt. The time can be accumulated on multiple visits thruout the day until midnight. Yes you can do any hospital encounter (E/M) then code the critical care. However you can not go backwards(CC then Subseq or H&P) A great magazine / website is "TodaysHospitalist.com" Many articles to read in coding tips also look AT "critical care Society" (google it) I will view this site later if you have other questions just title it Hospital Codes or hopital/mancoder and I will spot it. Remember the patient has to have emergent need (you have that) your physicians involvement + documentation that clarifies such + the statement  _" I spent XX min providing CC services for this patient/ which does not include procedures" (initial)_ I train my docs to that statement because they cannot include procedure time(billed separate) leaves out any doubt! Hope that helps! Good luck


----------



## emartinez (Aug 22, 2010)

*Critical Care with CPR code*

Mancoder, just wanted to quick ask you in regards to billing critical care with a 92950 CPR code-- Am I justified in billing a 92950 with a critical care time if my physician supervises a CPR with a patient going into code blue, but all the work that went into provided CPR on the patient was of course done by staff? Physician states no physician actually does the whole hands on thing, they are basically there to supervise, and instruct staff what to do with patient when providing CPR on that patient. Can you bill a CPR code then? What kind of a documentation am I looking for to justify billing my CPR code with my critical care time? The physician dictates total critical care time spent, but what justifies billing a CPR code with it? Other coders are telling me, bill only critical time while compliance agree billing both (critical care time with a modifier 25 and a 92950). Please help.


----------



## Grintwig (Aug 23, 2010)

I could be wrong, but I would only code for the CPR if my physician actually *performed* it.


----------



## emartinez (Aug 23, 2010)

Thanks for your response Grintwig, but based on my brief description as far as a physician supervising the CPR, would you then code this with the CPR code 92950? I was told to only bill critical care time. I have never billed both, but based on what was documented, I feel a CPR should be billed. Do you agree? Or can you tell me what justifies or what work is involved in billing a 92950? Being told to bill critical care time on this versus a CPR code just doesn't seem right to me. Your thoughts?


----------

