ED Coding and Reimbursement Alert

Question:Is there official documentation where both critical care and an ED level can be billed on the same date of service? I understand it is rare (most patients come in critical) and requires additional work to get reimbursement and that not all payers will reimburse for both on the same day, but it is a possible billing situation, correct or incorrect? And is there any official documentation to support this situation?Mississippi SubscriberAnswer:CPT® specifically states that critical care and other E/M services may be provided to the same patient on the same day by the same physician. In fact, that is a direct quote, but Medicare does not allow both services to be reported in the emergency department setting.CMS describes the criteria in which they will pay for both a regular E/M and a critical care code in. In Pub 100-4, Chapter 12, Section 30.6.12 (H), the text is as follows:H. [...]