Cardiology Coding Alert

Question: Is it appropriate to use inpatient admission codes 99221-99223 or inpatient consult codes 99251-99255 with critical care code 99291, or are they considered mutually exclusive? My cardiology group doesnt use 99291 with other inpatient E/M codes. We wonder if we are missing out on an appropriate billing opportunity.

Georgia Subscriber

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Answer:If the critical care was the first encounter of the day, all other evaluation and management services are bundled into it for that date, says Terry Fletcher, BS, CPC, CCS-P, an independent cardiology coding and reimbursement specialist in Dana Point, Calif. If the critical care was provided at a different time, however, it can be billed separately.

For example, if the patient was admitted for angina, but later developed cardiogenic shock, both the admit and the critical care could be billed, Fletcher says, but modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) should be attached to the admit code.

You also should be prepared to submit hard copy and documentation to demonstrate the times of the day that the services were rendered, she says.