# Critical Care and ED Same Day



## sparkles1077 (Apr 5, 2010)

One of our ED physicians sent me a FAQ from the American College of Emergency Physicians indicating CC and ED can be billed on the same day.

Is there a resource(besides CMS) to describe the difference between what he is seeing on the ACEP website (AMA guidelines I believe) and CMS regulations?

Any guidance greatly appreciated!

Diana


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## mcpalmeter (Apr 6, 2010)

*Critical Care on same Day as E/M*

See CPT 2010 Instructional Notes under Critical Care Services.  Per CPT, "Critical care and other E/M services may be provided to the same patient on the dame date by the same physician."


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## FTessaBartels (Apr 6, 2010)

*Careful of double dipping*

NONE of the documented ED service can be used as critical care time if you are going to bill critical care separately.

NONE of the time spent in performing procedures (intubation, chest tube, CPR) can be used as critical care time if you are billing both critical care and the procedures. 

Two (or more) providers cannot simultaneously be providing critical care to the same patient at the same time.  So if the hospitalist, or the intensivist, or the trauma surgeon are also in the ED along with the ED doc providing critical care, only one physician will be able to code for critical care. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## sparkles1077 (Apr 28, 2010)

Thank you everyone for your replies.  It seems like my password changes every time I come in here, so I have not been able to get back and say thank you.

Upon further investigation, it does appear that commercial plans will pay both the ED and Critical Care.  Medicaid pays the Critical Care only.

The ED physicians use an electronic template where all E and M elements can be dropped down.  They do all the drop downs, and then add the CC documentation in the free text.  

Can someone refer me to documentation examples or resources so I can understand what an outside auditor would look for when trying to determine at what point the ED documentation ends, and the Critical care begins?  If the physician documents the CC time, wouldn't an auditor assume this is the CC time only, and none of the ED time is added in?  

Does the note have to show the patient's condition was resolved at the end of the ED service, and then the condition declined requiring Critical care services?

Thank you 
Diana
Physician Coding Auditor, CPC


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## FTessaBartels (Apr 28, 2010)

*All one note?*

If it was all one note, with just the free text notation of "30 minutes of direct critical care provided," I would count it ALL at critical care and not count anything as a separate E/M.  It is up to the provider to document two separate services if s/he expects to code for, bill, and be paid for two "Significant, separately identifiable" E/M services. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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