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Colliemom

Colliemom

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When performing Critical Care on the same day as an inpatient consultation, do you bill both the consultation and the critical care codes? (I have my own opinion on this, but my manager wants me to see what other practices do in this scenario)
 
Colliemom said:
When performing Critical Care on the same day as an inpatient consultation, do you bill both the consultation and the critical care codes? (I have my own opinion on this, but my manager wants me to see what other practices do in this scenario)
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Critical care is its own thing, and can be reported separately. The usual site of service hierarchy, doesn't apply. Per CPT guidelines, "Critical care and other E/M services may be provided to the same patient on the same date by the same physician." (page 21);)
 
Colliemom said:
When performing Critical Care on the same day as an inpatient consultation, do you bill both the consultation and the critical care codes? (I have my own opinion on this, but my manager wants me to see what other practices do in this scenario)
Click to expand...


The way we handle that situation -
if there are two separate notes/diagnoses that show why the physician had to come back and later provide critical care, then we would bill both and be reimbursed for both.
If it was for the same reason, then I would argue that you only bill one, the critical care. I've found that we don't get reimbursed for two E/M codes, even critical care and something else, if the primary diagnoses/documentation are for the same reason.
 
alincoln said:
The way we handle that situation -
if there are two separate notes/diagnoses that show why the physician had to come back and later provide critical care, then we would bill both and be reimbursed for both.
If it was for the same reason, then I would argue that you only bill one, the critical care. I've found that we don't get reimbursed for two E/M codes, even critical care and something else, if the primary diagnoses/documentation are for the same reason.
Click to expand...

If the critical care and consult happened simultaneously, then that would indicate that the patient had already lapsed into a 'critically ill' status, at the time they were consulted, and the doctor was merely assisting in the critical care of the patient. If that's the case, then no, don't bill a separate consult. But, if the two occurred independently, you should be able to be reimbursed with both, but probably only after sending an appeal with records showing that the incidences didn't occur at the same time.

Don't forget, to be considered a true "consultation", you must have 2 things documented:
1. A request for a doctor's professional opinion, regarding the patient's condition, or plan of treatment, from a qualified source
2. The consulting MD's written report with recommendations, sent back to the requestor.

And Medicare doesn't cover consult codes, so use an inpatient hospital code, instead, for them.
 
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