Wiki Uncertain?

[chavera]

Hello,

I need some help clarifying whether the doctor can bill an initial hospital visit 99223 with a critical care 99291 on the same day?

Thanks

 

[mhstrauss]

Hello,

I need some help clarifying whether the doctor can bill an initial hospital visit 99223 with a critical care 99291 on the same day?

Thanks

Per CPT Guidelines,"Critical Care and other E/M Services may be provided to the same patient on the same date by the same individual"; this is under the Critical Care section. However, not all payers will pay both. Our MAC will not allow both, but most of our commercial payers will.

Hope this helps!

 

[RebeccaWoodward*]

Hello,

I need some help clarifying whether the doctor can bill an initial hospital visit 99223 with a critical care 99291 on the same day?

Thanks

A. Hospital Visit and Critical Care on Same Day

When a hospital inpatient or office/outpatient evaluation and management service (E/M) are furnished on a calendar date at which time the patient does not require critical care and the patient subsequently requires critical care both the critical Care Services (CPT codes 99291 and 99292) and the previous E/M service may be paid on the same date of service. Hospital emergency department services are not paid for the same date as critical care services when provided by the same physician to the same patient.

Page 57

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

 

[chavera]

Thank you