Can 99291 and 99238 be billed for the same day if the patient passes away (it's critical care if that makes a difference)? I've been reading conflicting information about it.
I just found an MLN Booklet MLN006764 August 2023
Evaluation and Management Services Guide which provides specific information on when you can code critical care codes 99291-292 on the same day as another E&M service. Towards the bottom of page 5 it states the following:
Critical Care & Other Same-Day E/M Visits Starting February 15, 2022, you may bill hospital E/M visits the same day as critical care services in certain circumstances. See CR 12543.
For other E/M services billed for the same patient on the same date as a critical care service, document that the service is:
● Provided before the critical care service at a time when the patient didn’t require critical care
● Medically necessary
● Separate and distinct, with no duplicative elements from the critical care service provided later in the day
Use modifier 25 (same-day significant, separately identifiable E/M service) on the claim when you report critical care services unrelated to the service or procedure that you perform on the same day. You must also document the medical record with the relevant criteria for the respective E/M service you’re reporting.
In your case the provider would've had to provide the 99238 discharge management services prior to the patient taking a turn for the worse. At which point the provider would've then begun to provide critical care services to the patient, followed by the patient passing away during the course of critical care treatment.
These are time based codes so the documentation is uber important. I'm guessing this is going to be a tricky case and the provider's documentation is going to have to be very detailed about the order of events of their care of the patient that day. Including the time spent on the discharge management code 99238, followed by the time spent providing critical care services billed with 99291. The provider would need to have completed their discharge management services and then before the patient leaves the hospital their condition would need to deteriorate to the point that the provider begins to render critical care services 99291 to the patient and the eventual death of the patient.