# Uncertain?



## chavera (Jun 10, 2013)

Hello,

I need some help clarifying whether the doctor can bill an initial hospital visit 99223 with a critical care 99291 on the same day?

Thanks


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## mhstrauss (Jun 10, 2013)

chavera said:


> Hello,
> 
> I need some help clarifying whether the doctor can bill an initial hospital visit 99223 with a critical care 99291 on the same day?
> 
> Thanks



Per CPT Guidelines,"Critical Care and other E/M Services may be provided to the same patient on the same date by the same individual"; this is under the Critical Care section.  However, not all payers will pay both.  Our MAC will not allow both, but most of our commercial payers will.

Hope this helps!


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## RebeccaWoodward* (Jun 10, 2013)

chavera said:


> Hello,
> 
> I need some help clarifying whether the doctor can bill an initial hospital visit 99223 with a critical care 99291 on the same day?
> 
> Thanks



*A. Hospital Visit and Critical Care on Same Day*

When a *hospital inpatient* or office/outpatient evaluation and management service (E/M) are furnished _on a calendar date at which time the patient does not require critical care and the patient *subsequently* requires critical care both the critical Care Services (CPT codes 99291 and 99292) and the previous E/M service may be paid on the same date of service._ Hospital emergency department services are not paid for the same date as critical care services when provided by the same physician to the same patient.

Page 57

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf


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## chavera (Jun 11, 2013)

Thank you


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