Wiki critical care place of service

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maryawinfield04

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My cardiologist was with a patient once the visit was over he had a near syncope experience and he fainted she had to revive him and call the ambulance where she then admitted him into the hospital. Can critical care codes (99291,99292) be billed in an office setting (11) because I'm getting denied for invalid pos and the description for critical care codes aren't 100% clear on what pos can be billed.

Mary Winfield, CPC
 
this is the lay description in Encoder pro

INCLUDES: 30 minutes or more of direct care provided by the physician to a critically ill or injured patient, regardless of the location
 
maryawinfield04 said:
My cardiologist was with a patient once the visit was over he had a near syncope experience and he fainted she had to revive him and call the ambulance where she then admitted him into the hospital. Can critical care codes (99291,99292) be billed in an office setting (11) because I'm getting denied for invalid pos and the description for critical care codes aren't 100% clear on what pos can be billed.

Mary Winfield, CPC
Click to expand...

I work for a Pulmonary/Critical Care group and we bill critical care frequently for hospital patients, I don't have any experience with us billing it in the office, although I know you are supposed to be able to bill it in ANY location.

Good luck! Would be nice to hear what you find out...
 
Patient admitted same day ...

Mary Winfield - I believe your problem may lie in this one little phraase ... where she then admitted him into the hospital.

If the patient was admitted the same DOS by the same doctor (i.e. she OR someone in her same practice/ same specialty) then ALL E/M services provided that DOS should be rolled together to form ONE inpatient code (either initial hospital visit or critical care).

Your physician MAY be able to separately code CPR, if performed and documented.

IF your physician was not the admitting physician (and no other physician from the same practice/specialty was the admitting physician), THEN you probably just need to provide the notes with your appeal.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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